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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 Japanese 2 nd Nationality
(In case of dual
citizenship,
mention
the name)
No
Place of Birth: HIROSHIMA Date of Birth: 15 Nov 1963
Country of
Birth
Japan ID in applicant’s
Country:
N/A
Passport
number:
MZ1240595 Passport issue
Date:
07 May 2019
Passport
validity date:
07 May 2024 Passport Issuing
authority:
Embassy of Japan in Sri
Lanka
Visa number: A2344137 Visa issue date: 08 July 2022
Visa Category: Employment Visa validity date: 08 October 2022
Visa issuing
authority:
High Commission
of People’s
Republic of
Bangladesh.
Date of
application for visa
extension
N/A
Duration of
stay in
Bangladesh
according to
visa status:
90 days Place of visa issue
From:
Tokyo, Japan
HIROKI HORIKAWA
Male TAISEI CORPORATION
Land phone
Number:
E-mail address: horikawa@ce.taisei.co.jp
Cell phone
number:
01881115008 Date of first
arrival in
Bangladesh:
20 July 2019
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:
22 July 2022
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-25Jul2022-00036
1 (One) year
Validity date
of
Work
Permit:
21 July 2023 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:
N/A
1. Resident address in Bangladesh:
2. Your designation in your office:
3. Educational Qualification and institution’s name:
4. Employment History (in Bangladesh & Abroad):
Renaissance Dhaka Gulshan Hotel
78 Gulshan Avenue, Dhaka, Bangladesh, 1212
General Manager
Advance Course of Environmental
Science and Engineering
HIROSHIMA UNIVERSITY
TAISEI CORPORATION
In Bangladesh from 22 July 2022 to Present;
In Japan “Taisei Corporation” started in 1988 from 1988 to 2001 worked in
(Domestic Branches)
In Hong Kong he worked till 2004 Taisei International Branch as a position of “Deputy
Project Manager”
In Sri Lanka from 2004 to 2013 for the project in the same position as a “Deputy
Project Manager”
In Sri Lanka from 2014 to 2020 he worked in Taisei Corporation Marketing and
Business Development Department as a position of “General Manager” .
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: HIROKI HORIKAWA
SIGN:
DATE: