OA0000003038831 (Ryo San)

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: RYO MIZUNOURA 070-4498-0450 mizunoura.ryo@kusuhara.co.jp AZHAR COMFORT COMPLEX, LEVEL-3, 130/A MIDDLE BADDAH, PRAGOTI SARONI, DHAKA 1212 013-1676-5519 23/10/1989 KAGOSHIMA 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: TR5865545 11/04/2016 11/04/2026 02/07/2022 A 2513457 09/08/2021 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) 9028, Yoshino-Cho, Kagoshima-ken, 892-0871, Japan, Japan Contact No.: Email: mizunoura.ryo@kusuhara.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 SINGLE 13. Place of Issue: MINISTRY OF FOREIGN AFFAIRS Web Application 19. Place of Issue: 20. Date of Expiry: AGARGAON 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: 02/07/2022 31. Visa No: A 2513457 DD / MM / YYYY in Bangladesh: E 33. Date of Issue: EMPLOYMENT AGARGAON 35. Place of Issue: 09/08/2021 DD / MM / YYYY 34. Date of Expiry: 04/08/2022 DD / MM / YYYY 2 Year(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 04/08/2022 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 (RYO MIZUNOURA) Bangladesh 02/07/2022 √ √ √ √ √ √ √ √ 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 OA0000003038831