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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 .
a I Name:
b I Sex: M C. Name of company/firm C.
Nationality Japan 2 nd Nationality
(In case of dual
citizenship,
mention
the name)
N/A
Place of Birth: Tokyo, Japan Date of Birth: 27 th July 1976
Country of
Birth
Japan ID in applicant’s
Country:
N/A
Passport
number:
TT2295087 Passport issue
Date:
28 th June 2022
Passport
validity date:
28 th June 2032 Passport Issuing
authority:
Ministry of Foreign Affairs
Visa number: A 2448388 Visa issue date: 9 th October 2023
Visa Category: E Visa validity date: 9 th January 2024
Visa issuing
authority:
Embassy of the
People’s Republic
of Bangladesh,
Tokyo, Japan
Date of
application for visa
extension
N/A
KUNIO MIZUTANI
Male TAMURAKOMA & CO., 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: kunio_mizutani@tamurakoma.co.jp
Cell phone
number:
01400562775 Date of first
arrival in
Bangladesh:
15 th July 2022
Name of the
Immigration
checkpoint
While
Arriving first
time
in
Bangladesh:
Hazrat Shahjalal
International
Airport, Dhaka.
Immigration police,
Bangladesh.
Date of last visit to
Bangladesh:
23 rd October 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-250ct2023-00006
1 Year
Validity date
of
Work
Permit:
22 nd October 2024 Please mentioned
the date,
if you have
applied for
extension of your
work permit:
Do you pay tax
to Bangladesh
Government
N/A Does your office
Activity has any
affiliation with the
offices of
Bangladesh
Government:
No
Are you
engaged
With any other
occupation in
Bangladesh:
No If applicant
Engaged
with other jobs
then
clarify 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):
8 th Floor, House #37, Road #02, Sector #13, Uttara,
Dhaka
Merchandising Manager
Bachelor in Fashion Designing
Dressmaker Gakuin Graduate
Ø 2001-2021- Five Foxes Co. Ltd.
Director
Ø 2022- Ken2 Co. Ltd.- Officer