Security Clearance
Form-2
(To be filled by applicant)
Reference:
Subject: Personal Information.
Please find the information furnished here under for your ready reference .
a I Name:
b I Sex: M C. Name of Company/firm
Nationality Japan 2 nd Nationality
(In case of dual
citizenship,
mention
the name)
N/A
Place of Birth: Tokyo, Japan Date of Birth: 29 th January 1996
Country of
Birth
Japan ID in applicant’s
Country:
N/A
Passport
number:
TT2494792 Passport issue
Date:
25 th August 2022
Passport
validity date:
7 th May 2029 Passport Issuing
authority:
Ministry of Foreign Affairs, Japan
Visa number: A2444266 Visa issue date: 22 nd February 2023
Visa Category: E Visa validity date: 22 nd May 2023
Visa issuing
authority:
Embassy of the
People’s Republic
of Bangladesh,
Tokyo, Japan
Date of
application for visa
extension
N/A
MIZUKI HONDA
Female Nippon Koei Bangladesh Ltd.
Duration of
stay in
Bangladesh
according to
visa status:
90 Days
Place of visa issue
From: Tokyo, Japan
Land phone
Number:
N/A E-mail address: A8847@n-koei.co.jp
Cell phone
number:
+81-3-5276-7769,
01402-190294
Date of first
arrival in
Bangladesh:
14 th October, 2022
Name of the
Immigration
checkpoint
While
Arriving first
time
in
Bangladesh:
Hazrat Shahjalal
International
Airport, Dhaka.
Immigration police,
Bangladesh.
Date of last visit in
Bangladesh:
26 th March 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:
WPN-13Mar2023-00016
1 year
Validity date
of
Work
Permit:
28 th February, 2024 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
1. Resident address in Bangladesh:
2. Your designation in your office:
3. Educational Qualification and institution’s name:
4. Employment History (in Bangladesh & Abroad):
Jun. 2020 - Sept. 2022 ： International Marketing and Promotion Dept., Nippon Koei Co., Ltd.
Nov. 2019 – May, 2020 ： Legal and Compliance Dept., Nippon Koei Co., Ltd.
Apr. 2019 - Oct. 2022 ： Accounting Dept., Nippon Koei Co., Ltd.
5. Travel record for the last 3 years:
"Concord Kabir Tower" Apt #8B (8th floor), 31 Rd
100, Gulshan 2, Dhaka 1212, Bangladesh
Manager
Bachelor of Liberal Arts
Saitama University
Please see next page.
6. Are you engaged with any social/ cultural activities apart from your present occupation in
Bangladesh? If yes please provide details:
7. Is your spouse(S) residing with you in Bangladesh? If yes please furnish:
SL
No
Name Pass port
Number
Relation With You
NAME: MIZUKI HONDA
SIGN:
DATE:
No.