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POLICE said on Monday that security camera footage showed the woman slipped and fell from the tuk-tuk with the driver travelling at low speed.
The unusual tragedy came about 3am as the woman and her male companion returned from an evening in Soi Bangla, Patong, to their resort at Surin beach.
There is one very sharp bend on the road through Kamala, just metres from the local police station and a Muslim cemetery, and that's believed to be the spot where the woman toppled out.
Driver Yongyut Damkong, 44, passed a breath test, according to police.
Khun Yongyut told police he was doing no more than 40 kmh when the tourist tumbled to the roadway.
The woman's body was taken to Vachira Phuket Hospital in Phuket City.
It's not the first time a tourist has fallen to their death from the rear of a tuk-tuk.
Hanging off the back of a moving vehicle is as dangerous in Thailand as it is everywhere else.
British tourist Rebecca Leanne Shaw, 32, was killed last Saturday when the motorcycle she and a friend were riding collided with a pickup on the Patong Hill road.