Security Clearance
Form-2
(To be filled by applicant)
Reference: 03.219.344.00.00.0000.474.08022016
Subject: Personal Information.
Please find the information furnished here under for your ready reference.
HIDEYUKI TAGUMA
a I Name:
ASTY INC.
Male
b I 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:
12th April, 1979
Country of Birth
Japan
ID in applicant’s
Country:
Passport number:
MU6080672
Passport issue
Date:
17th May, 2017
Passport validity date:
17th May, 2022
Passport Issuing authority:
Ministry of Foreign Affairs
Visa number:
A0936855
Visa issue date:
11th October, 2018
Visa Category:
Employment
Visa validity date:
11th January, 2019
Visa issuing authority :
Embassy of the People’s Republic of Bangladesh, Tokyo
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:
taguma@asty.co.jp
Cell phone
number :
+880-1675400453
Date of first
arrival in
Bangladesh:
15th October,2018
Name of the Immigration checkpoint
While
Arriving first time
in
Bangladesh :
Hajrat Shahjalal international Airport , Dhaka .immigration police , Bnagladesh
Date of last visit in Bangladesh:
15th October,2018
Name of the
immigration cheek point while
Arriving last time
In
Bangladesh
Do
Date of enrolment
In foreigner’s
Registration office
Do you possess
Any
Work permit?
Yes
Number &
duration of
work permit:
03.219.344.00.00.000019512.18102018.
1 (one) year
Validity date of
Work
Permit:
One year from
15. 10. 2018
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:
No
Resident address in Bangladesh:
House # 08, (1st, 3rd & 4th Floor), Road # 13,
Sector # 03, Uttara, Dhaka-1230
2. Your designation in your office:
Country Manager
Graduation,
3. Educational Qualification and institution’s name:
Yamaguchi University, Japan.
From 15th October, 2018 to present in Bangladesh.
4. Employment History (in Bangladesh & Abroad):
N/A
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: HIDEYUKI TAGUMA
SIGN:______________________.
DATE: