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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.
Hiroshi Kajitani
a I Name:
Summit Bibiyana Power Company Limited.
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:
Shiga
Date of Birth:
21st October 1981
Country of Birth
Japan
ID in applicant’s
Country:
Passport number:
TT4072282
Passport issue
Date:
20th July 2023
Passport validity date:
20th July 2033
Passport Issuing authority:
Ministry of Foreign Affairs
Visa number:
A 3744186
Visa issue date:
8th July 2024
Visa Category:
E
Visa validity date:
8th October 2024
Visa issuing Authority:
Embassy of Bangladesh, Tokyo, Japan.
Date of
application for visa extension
10th August 2024
Duration of stay in Bangladesh according to
visa status:
As Required
Place of visa issue
From:
Tokyo, Japan
Land phone
Number:
E-mail address:
hiroshi.kajitani@summit-centre.com
Cell phone
number:
01787690857
Date of first
arrival in
Bangladesh:
5th February 2024
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:
16th July 2024
Name of the
immigration cheek point while
Arriving last time
In
Bangladesh
Do
Date of enrolment
In foreigner’s
Registration office
Not Applicable
Do you possess
Any
Work permit?
Yes
Number &
duration of
work permit:
WPN-18Jul2024-00014
1 year
Validity date of
Work
Permit:
15th July, 2025
Please mentioned
the date,
if you have
applied for
extension of your
work permit:
Not Applicable
Do you pay tax to Bangladesh
Government
Exempted
Does your office
Activity has 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:
Not Applicable
Road-96, House-8, Apartment-A3, Gulshan-2, Dhaka-1212, Bangladesh
Resident address in Bangladesh:
Deputy General Manager
2. Your designation in your office:
Master's Degree.
3. Educational Qualification and institution’s name:
Shinshu University, Japan.
Attached with Resume
4. Employment History (in Bangladesh & Abroad):
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: Hiroshi Kajitani
SIGN:
DATE: