Security Clearance
Form-2
(To be filled by the applicant)
Reference:
Subject: Personal Information.
Please find the information furnished here under for your ready reference.
KENJI TAKEDA
a I Name:
MIURA BANGLADESH CO., LTD.
Male
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:
Chiba
Date of Birth:
6th April, 1981
Country of Birth
Japan
ID in applicant’s
Country:
N/A
Passport number:
TZ2133797
Passport issue
Date:
2nd August, 2022
Passport validity date:
2nd August, 2032
Passport Issuing authority:
Embassy of Japan in Thailand
Visa number:
A 2100620
Visa issue date:
14th March, 2024
Visa Category:
E
Visa validity date:
14th June, 2024
Visa issuing authority:
Embassy of the People’s
Republic of Bangladesh
Bangkok
Date of
application for visa extension
N/A
Duration of stay in Bangladesh according to
visa status:
As Required
Place of visa issue
From:
Bangkok, Thailand
Land phone
Number:
N/A
E-mail address:
takeda_kenji@miuraz.co.jp
Cell phone
number:
01332-567790
Date of first
arrival in
Bangladesh:
31st January, 2024
Name of the Immigration checkpoint
While
Arriving first time
in
Bangladesh:
Hazrat Shahjalal International Airport.
Date of last visit in Bangladesh:
26th March, 2024
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-30Mar2024-00004
> 2 years
Validity date of
Work
Permit:
25th March, 2026
Please mentioned
the date,
if you have
applied for
extension of your
work permit:
N/A
Do you pay tax to Bangladesh
Government
Yes
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
House # 08, Road # 06, Apartment #302, Baridhara Diplomatic Zone. Dhaka-1212, Bangladesh.
Resident address in Bangladesh:
General Manager
2. Your designation in your office:
Bachelor in Department of Systems Engineering.
3. Educational Qualification and institution’s name:
Nippon Institute of Technology.
4. Employment History (in Bangladesh & Abroad):
Period
Organization
Position
December 2007
Miura Protech Co., Ltd. in the Techno Tokyo Maintenance Area.
April 2008
Miura Kogyo Co., Ltd.
December 2011
Saitama Sales Office
April 2014
Moved to the Nishi Saitama Branch and joined the Kawagoe Sales Office.
Member
April 2015
Nishi Saitama Branch and continued working at the Kawagoe Sales Office.
Maintenance Chief.
April 2019
Thailand Representative Department at MIURA INDUSTRIES (THAILAND) CO., LTD.
Chief
June 2020
Thailand Representative Department, at MIURA INDUSTRIES (THAILAND) CO., LTD.
Section Chief
June 2021
Thailand Representative Department, at MIURA INDUSTRIES (THAILAND) CO., LTD.
Manager
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: KENJI TAKEDA
SIGN:
DATE: