Security Clearance
Form-2
(To be filled by applicant)
Reference:
Subject: Personal Information.
Please find the information furnished here under for your ready reference.
KOUSHIK SINGHA
a I Name:
Nippon Signal Company Limited
Male
b I Sex: M C. Name of company/firm C.
Nationality
Indian
2nd Nationality
(In case of dual citizenship,
mention
the name)
No
Place of Birth:
Baidyanathpur, West Bengal, India
Date of Birth:
2 March, 1990
Country of Birth
India
ID in applicant’s
Country:
N/A
Passport number:
N3831986
Passport issue
Date:
14 October, 2015
Passport validity date:
13 October, 2025
Passport Issuing authority:
Bangladesh High Commission, Kolkata.
Visa number:
A 2050254
Visa issue date:
5 November, 2021
Visa Category:
Employment
Visa validity date:
5 November, 2022
Visa issuing authority :
Bangladesh High Commission, Kolkata, India
Date of
application for
visa extension
N/A
Duration of stay in Bangladesh according to
visa status:
As Required
Place of visa issue
From:
Calcutta, India
Land phone
Number:
E-mail address:
koushik.singha0@gmail.com
Cell phone
number:
+9934967855
Date of first
arrival in
Bangladesh:
11 November, 2021
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:
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-15Nov2021-00001
1 (One) Year
Validity date of
Work
Permit:
10 November 2022
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:
Yes
Are you engaged
With any other
occupation in Bangladesh:
No
If applicant
Engaged
with other job
then
clarify of that:
N/A
CP-7 project office, Block I, Sector 16,
Resident address in Bangladesh:
Road: Sonargoan Janapath, Diabari, Uttara, Dhaka-1230, Bangladesh
Signaling Engineer (Signaling System)
2. Your designation in your office:
Bachelor of Technology (B.Tech) in Electronics & Communication EngEng.
3. Educational Qualification and institution’s name:
Camellia Institute of Technology
Nippon Signal Company Limited
4. Employment History (in Bangladesh & Abroad):
In Bangladesh from 11 November, 2021 to Present;
In India-Technological Site Supervisor (S&T)” Hitachi Rail STS from 2017 to 2021
In India “Site Engineer” in Radharani Rail Engineering systems Pvt. ltd. from 2013 to 2017
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: KOUSHIK SINGHA
SIGN:
DATE: