Old OA0000004646203

Male Others Female 01. Full Name: Last / Surname 02. Permanent Address: Contact No.: Email: 03. Address in Bangladesh: DD / MM / YYYY 04. Date of Birth: 05. Sex: 06. Place of Birth: 07. Present Nationality: 08. Nationality at Birth: 09. Occupation: 10. Marital Status: MASAKAZU SOTA 6-3 1-2 HIGASHIHONGO, MIDORI-KU, YOKOHAMA-CITY, KANAGAWA PREFECTURE,JAPAN 08095449838 sotasota@ce.taisei.co.jp 10TH FLOOR, HOUSE 133, ROAD 12, BANANI, DHAKA, BANGLADESH 01894981819 17/12/1973 KANAGAWA Japanese Japanese PRIVATE SERVICE PERSONAL DETAILS TRAVEL DOCUMENT DETAILS 11. Passport No: 12. Type of Passport: 14. Date of Issue: 15. Date of Expiry: 16. Date of Last Visit to Bangladesh: 17. Last Visa No.: 18. Date of Issue: TZ2063243 07/07/2021 07/07/2031 09/09/2024 A 3760683 28/05/2024 ORDINARY Government of the People's Republic of Bangladesh D.I.P Form-4(Free of cost) Department of Immigration & Passports Machine Readable Visa Application Form First / Given Name(s) Contact No.: Email: sotasota@ce.taisei.co.jp (as in the passport) DD / MM / YYYY DD / MM / YYYY DD / MM / YYYY DD / MM / YYYY AGARGAON * Name of Office / Bangladesh Mission: * Please Go Through The General Instructions Before Filling Up The Visa Form. * This Form Should Be Filled Up In Capital Letters. Put A Check [ √ ] In Appropriate Box. Single Seperated Married Divorced Widowed Engaged Invalid Annulled Cohabitating Deceased Spouse's Death Common Law None Others MARRIED 13. Place of Issue: EMBASSY OF JAPAN IN SRI LANKA Web Application √ √ 19. Place of Issue: 20. Date of Expiry: Srilanka PAYMENT DETAILS 21. Name of the Bank and Branch: 22. Cheque/Bank Transfer/Chalan/Scroll No.: 23. Amount Deposited: 24. Date: NEW VISA , DD / MM / YYYY 25. Purpose of Visit: 26. Duration of Proposed Stay in Bangladesh: 27. Tentative Date of Arrival in Bangladesh: 28. Intended Number of Entries: DD / MM / YYYY Business Dependent Diplomatic Single Re-Entry Multiple Employment Investment Official Student Tourism Transit Others (Please Specify) 30. Date of Arrival 37. Duration of Proposed Extension: 36. Purpose of Extension of Visa: 32. Type of Visa: 09/09/2024 31. Visa No: A 3760683 DD / MM / YYYY in Bangladesh: E 33. Date of Issue: EMPLOYMENT Srilanka 35. Place of Issue: 28/05/2024 DD / MM / YYYY 34. Date of Expiry: 10/09/2024 DD / MM / YYYY 3 Month(s) 29. Name of the Father/Mother/Spouse/Other(Relation): EXTENSION OF VISA NO VISA REQUIRED FOR TRAVEL TO BANGLADESH 39. Father's Name: 47. Type of Visa: 42. Date of Arrival in Bangladesh: 48. Reason For Proposed NVR: 40. Mother's Name: 41. Spouse Name: Nationality: Nationality: Nationality: DD / MM / YYYY DD / MM / YYYY 43. Visa No: 44. Date of Issue: DD / MM / YYYY 45. Date of Expiry: 46. Place of Issue: 38. Intended Number of Entries: Single Re-Entry Multiple 10/09/2024 DD / MM / YYYY (Taka/US$) √ CHECK LIST Recommendation from concern Ministry Authority Security Clearance / Security Certificate Father's / Husband's / Mother's Visa copy Passport Copy, Last Visa and Last Arrival Page Father's / Husband's / Mother's Passport copy N. O. C from Sri Lankan High Commission Bi-Lateral Agreement / Multilateral Agreement Trade license of the sponsoring Company Payment Slip Over stay Payment Slip Marriage Certificate Birth Certificate Work Permit Affidavit Photo Income Tax Certificate of the Company TIN TIN Certificate of the Company Others I hereby declare that statements given above are true and will not request to refund my paid visa fee even if my Application is declined. Place: Date: DD / MM / YYYY Signature (MASAKAZU SOTA) Bangladesh 09/09/2024 √ √ √ √ √ TRANSIT/ON ARRIVAL VISA 53. Travelled by(Vessel's/Flight/Vehicle Name & No): 51. Date of Arrival in Bangladesh: 55. Purpose of Visit to Bangladesh: DD / MM / YYYY 52. Name of check post: 56. Duration of Proposed Stay: 54. From: 49. Amount of Investment (For Investor): 50. Name and Address of Company: Incorrect Correct POLICE VERIFICATION Memo No Date DD / MM / YYYY Information's are found If not correct: Reasons: Signature and Seal of Inquiry Officer Signature and Seal of Issuing Officer FOR OFFICIAL USE Reference No: Date: Amount of Fee: Visa No: Date: Date Expiry: Number of Entries Extension Re-Entry Multiple Entries NVR Date: Recipient's Signature Date & Seal Authorized Signature OA0000004646203