People's Republic of Bangladesh
MRV Delivery Slip - DHAKA
Enrolment Details
Counter
Deposit Date
Call Date
/\pphcation Type
Purpose Of Visit
Applicant's Details
First Name
Last Name
First Name on Visa
Last Name on Visa
Date of Birth
Present Nationality
Sex
Contact Number(Permanent)
Contact Number(Bangladesh)
Permanent Address
Address in Bangladesh
Visa Printed Date
Received By
Visa No
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USER-HP12
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31/05/2023 (If holiday, then ,next w~Rih!l_ d~y)
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VISA EXTENSION , "'. c~ · :, .,-':,'
16/05/2023
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EMPLOYMENT "',![{' ' .. "-· '
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TAKASHI
NAKAHASHI
TAKASHI
NAKAHASHI
15/09/1964
JPN - Japanese
MALE
01729201902
01729201902
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32-6, SAKURA 3-CHOME, SETAGAYA-KU, TOKYO
1560053, JAPAN.,
FLAT 13A, HOUSE# 26, ROAD# 47, GULSHAN ,
DHAKA.,
Passport Number
Number of Entries
Fee
Fee Receipt
Over Stay Fees
Over Stay Receipt Number
1111111111111111111111111111111111111111111111111111111
2601V0000526078
TS4718692
MULTIPLE
Operator's S\
Applicant's Signature
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