The original file is kept in the office. This is the text saved from it.
1 page
100%
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
Nationality Japanese 2 nd Nationality
(In case of dual
citizenship,
mention
the name)
N/A
Place of Birth: NARA Date of Birth: 27 th February 1964
Country of
Birth
JAPAN ID in applicant’s
Country:
Passport
number:
TT3637231 Passport issue
Date:
25 th May 2023
Passport
validity date:
25 th May 2033 Passport Issuing
authority:
Ministry of Foreign Affairs
Visa number: A 3746449 Visa issue date: 20 th December 2024
Visa Category: A3 Visa validity date: 20 th December 2025
Visa issuing
authority:
Tokyo, Japan. Date of
application for visa
extension
Yoko Khan
Female
International Manpower Development
Organization (IM) Japan
Duration of
stay in
Bangladesh
according to
visa status:
1 year Place of visa issue
From:
Tokyo, Japan
Land phone
Number:
E-mail address: khan@imm.or.jp
Cell phone
number:
Date of first
arrival in
Bangladesh:
4 th August 2023
Name of the
Immigration
checkpoint
While
Arriving first
time
in
Bangladesh:
Hazrat Shahjalal
International
Airport.
Date of last visit in
Bangladesh:
10 th January 2025
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:
1 year
WPN-22Jan2025-00007
Validity date
of
Work
Permit:
9 th January 2026 Please mentioned
the date,
if you have
applied for
extension of your
work permit:
N/A
Do you pay tax
to Bangladesh
Government
Yes Does your office
Activity have any
affiliation with the
offices of
Bangladesh
Government:
Yes
Are you
engaged
With any other
occupation in
Bangladesh:
No If applicant
Engaged
with other job
then
clarify of that:
No
1. 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:
Flat No: 5-A, Plot No: 394, Road No: 14, Savar DOHS,
Savar, Dhaka,
Japanese Teacher
Bachelor of English Faculty of Foreign
Studies.
Kyoto Sangyo University
Attached with Passport
Attached with Resume
6. Are you engaged with any social/ cultural activities apart from your present occupation in
Bangladesh? If yes please provide details:
7. Is your spouse(S) residing with you in Bangladesh? If yes please furnish:
SL
No
Name Passport
Number
Relation With You
NAME: YOKO KHAN
SIGN:
DATE:
No.