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Security Clearance
Form-2
(To be filled by applicant)
Reference: 03.219.344.00.00.0000.1783.10052018
Subject: Personal Information.
Please find the information furnished here under for your ready reference.
Mohamad Rizwan Bin Shahabuddin
a I Name:
MIURA SINGAPORE CO PTE. LTD.
Male
b I Sex: M C. Name of company/firm C.
Nationality
Malaysia
2nd Nationality
(In case of dual citizenship,
mention
the name)
Place of Birth:
Malaysia
Date of Birth:
10th February 1989
Country of Birth
Malaysia
ID in applicant’s
Country:
Passport number:
A50745379
Passport issue
Date:
03rd March 2018
Passport validity date:
03 September 2023
Passport Issuing authority:
UTC JOHOR
Visa number:
A1193515
Visa issue date:
11th October, 2018
Visa Category:
Employment
Visa validity date:
15th January, 2019
Visa issuing authority :
Embassy of the People’s Republic of Bangladesh, Kuala Lumpur
Date of
application for
visa extension
Duration of stay in Bangladesh according to
visa status:
90 days
Place of visa issue
From:
Kuala Lumpur, Malaysia
Land phone
Number:
E-mail address:
mohamad_rizwan@miuraz.co.jp
Cell phone
number :
+880-16-75400453
Date of first
arrival in
Bangladesh:
13th March, 2018
Name of the Immigration checkpoint
While
Arriving first time
in
Bangladesh :
Hajrat Shahjalal international Airport , Dhaka .immigration police , Bnagladesh
Date of last visit in Bangladesh:
20th October, 2018
Name of the
immigration cheek point while
Arriving last time
In
Bangladesh
Do
Date of enrolment
In foreigner’s
Registration office
Do you possess
Any
Work permit?
Yes
Number &
duration of
work permit:
03.219.344.00.00.000019542.21102018 1 (one) year
Validity date of
Work
Permit:
One year from
20. 10. 2018
Please mentioned
the date,
if you have
applied for
extension of your
work permit:
N/A
Do you pay tax to Bangladesh
Government
N/A
Does your office
Activity have any affiliation with the
offices of
Bangladesh
Government :
No
Are you engaged
With any other
occupation in Bangladesh:
No
If applicant
Engaged
with other job
then
clarify of that:
No
Resident address in Bangladesh:
House 32, Unit A3, 3rd Floor,
Gareeb-E-Nawaz Avenue, Sector, Uttara Model Town
Dhaka-1230.
2. Your designation in your office:
Country Manager
3. Educational Qualification and institution’s name:
Graduation, Applied Quantum Physics and Nuclear Engineering
Kyushu University
4. Employment History (in Bangladesh & Abroad):
(1st April, 2015 - 31st July, 2017) Miura Co., Ltd. Matsuyama Sales Office, in the Maintenance Department
(1st August 2017 – present) Miura Singapore Co Pte. Ltd. as a Service Engineer
N/A
5. Travel record for the last 3 years:
6. Are you engaged with any social/ cultural activities apart from your present occupation in Bangladesh? If yes please provide details:
No
7. Is your spouse(S) residing with you in Bangladesh? If yes please furnish:
SL
No
Name
Pass port
Number
Relation With You
NAME: Mohamad Rizwan Bin Shahabuddin
SIGN: _____________________.
DATE: