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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.
RYO MIZUNOURA
a I Name:
Kusuhara Transportation Co., Ltd.
Male
b I Sex: M C. Name of company/firm C.
Nationality
Japanese
2nd Nationality
(In case of dual citizenship,
mention
the name)
No
Place of Birth:
Kagoshima, Japan
Date of Birth:
23rd October, 1989
Country of Birth
Japan
ID in applicant’s
Country:
Passport number:
TR5865545
Passport issue
Date:
11 April, 2016
Passport validity date:
11 April, 2026
Passport Issuing authority:
Japan
Visa number:
-----
Visa issue date:
…………….
Visa Category:
Employment
Visa validity date:
11 January, 2020
Visa issuing authority :
Bangladesh Deputy High Commission, Japan
Date of
application for
visa extension
N/A
Duration of stay in Bangladesh according to
visa status:
Months
Place of visa issue
From:
Tokyo, Japan
Land phone
Number:
E-mail address:
Cell phone
number:
+88013-1676-5519
Date of first
arrival in
Bangladesh:
17 August, 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:
6 November, 2020
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:
Validity date of
Work
Permit:
One year from
17 August 2019
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:
N/A
Are you engaged
With any other
occupation in Bangladesh:
No
If applicant
Engaged
with other job
then
clarify of that:
N/A
Azhar Comfort Complex, Level-3, 130/A Middle Baddah,
Resident address in Bangladesh:
Baddah, Pragoti Saroni, Dhaka 1212
Manager
2. Your designation in your office:
Graduation
3. Educational Qualification and institution’s name:
University of Kitakyushu
Kusuhara Transportation Co., Ltd.
4. Employment History (in Bangladesh & Abroad):
In Bangladesh from 1st March, 2021 to Present;
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: RYO MIZUNOURA
SIGN:
DATE: