Subdivision: ............................................... ................................................
facility name base: ................................. ........ ..................................
tax code: ................................. .. ................................. ....... ....
Address: ... ........................... .............. [Name District ....] [Name Province ... ..]
person responsible the contents of the report: ............................................ ..................
Phone: .......................... Fax: ... ............................, Email:. ...... ....... ...
Subordinated (parent company name) : ................................................. ..............................
Address: ... ..................................... ... [name District ....] [name Province ... ..]
Phone: .......................... Fax: ... ..... ......................., Email:. ...... ....... ...
owner: (State / other economic sectors )
I. Information on infrastructure and operations
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