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Security Clearance Form-2
Reference:
Subject: Personal Information.
Please find the information furnished here under for your ready reference.
Shigeaki Misu
A.Name:
ASTY INC. Bangladesh Liaison office
B.Sex: M C. Name of company/firm C.
Nationality
Japan
2nd Nationality
(In case of dual citizenship,
mention
the name)
Place of Birth:
Japan
Date of Birth:
27th Jul 1985
Country of Birth
Japan
ID in applicant’s
Country:
Passport number:
TR3130894
Passport issue
Date:
17th Feb 2015
Passport validity date:
17th Feb 2025
Passport Issuing authority:
Visa number:
AO394015
Visa issue date:
04 May 2016
Visa Category:
Employment
Visa validity date:
04 Nov 2016
Visa issuing authority :
Date of
application for
visa extension
Duration of stay in Bangladesh according to
visa status:
90 days
Place of visa issue
From:
Tokyo, Japan
Land phone
Number:
E-mail address:
s-misu@asty.co.jp
Cell phone
number :
+880-16-7885-0096
Date of first
arrival in
Bangladesh:
Name of the Immigration checkpoint
While
Arriving first time
in
Bangladesh :
Date of last visit in Bangladesh:
Name of the
immigration cheek point while
Arriving last time
In
Bangladesh
Date of enrolment
In foreigner’s
Registration office
Do you possess
Any
Work permit?
YES
Number &
duration of
work permit:
One year from 10. 05. 2016
Validity date of
Work
Permit:
One year from 10. 05. 2016
Please mentioned
the date,
if you have
applied for
extension of your
work permit:
Do you pay tax to Bangladesh
Government
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
Resident address in Bangladesh:
2. Your designation in your office:
3. Educational Qualification and institution’s name:
4. Employment History (in Bangladesh & Abroad):
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: Shigeaki Misu
SIGN :
DATE :