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Security Clearance
Form-2
(To be filled by applicant)
Reference:
Subject: Personal Information.
Please find the information furnished here under for your ready reference.
FUKO YAMAGUCHI
a I Name:
Female
International Manpower Development Organization (IM) Japan
b I Sex: M C. Name of Company/firm
Nationality
Japanese
2nd Nationality
(In case of dual citizenship,
mention
the name)
N/A
Place of Birth:
NAGASAKI
Date of Birth:
23rd April 1999
Country of Birth
JAPAN
ID in applicant’s
Country:
Passport number:
TT2640231
Passport issue
Date:
12th December 2022
Passport validity date:
12th December 2032
Passport Issuing authority:
MINISTRY OF FOREIGN AFFAIRS
Visa number:
A 2444995
Visa issue date:
10th April 2023
Visa Category:
A3
Visa validity date:
10th April 2024
Visa issuing authority:
Embassy of the People’s Republic of Bangladesh, Tokyo, Japan.
Date of
application for visa extension
Duration of stay in Bangladesh according to
visa status:
As required
Place of visa issue
From:
Tokyo, Japan
Land phone
Number:
E-mail address:
yamaguchi.f@imm.or.jp
Cell phone
number:
01325-681300
Date of first
arrival in
Bangladesh:
21st January 2023
Name of the Immigration checkpoint
While
Arriving first time
in
Bangladesh:
Date of last visit in Bangladesh:
17th April 2023
Name of the
immigration cheek point while
Arriving last time
In
Bangladesh
Do
Date of enrolment
In foreigner’s
Registration office
N/A
Do you possess
Any
Work permit?
Yes
Number &
duration of
work permit:
1 year
WPN-09Jul2023-00008
Validity date of
Work
Permit:
16th April 2024
Please mentioned
the date,
if you have
applied for
extension of your
work permit:
N/A
Do you pay tax to Bangladesh
Government
No
Does your office
Activity have any affiliation with the offices of
Bangladesh Government:
Yes
Are you engaged
With any other
occupation in Bangladesh:
No
If applicant
Engaged
with other job
then
clarify of that:
No
6th Floor, Bureau of Manpower Employment and Training (BMET), 89/2 Kakrail, Ramna, Dhaka-1000. Bangladesh
Resident address in Bangladesh:
Japanese Teacher
2. Your designation in your office:
Faculty Of Letters Comparative Culture
3. Educational Qualification and institution’s name:
TSURU UNIVERSITY
4. Employment History (in Bangladesh & Abroad):
1st April,2022-16th April ,2023- International Manpower Development Organization
(IM) Japan (Japan Head office)- Japanese Teacher
17th April 2023-Currently working- International Manpower Development Organization
(IM) Japan (Dhaka Representative Office)- Japanese Teacher
5. Travel record for the last 3 years:
Attached with Passport
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
Passport
Number
Relation With You
NAME: FUKO YAMAGUCHI
SIGN:
DATE: