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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.
TAKESHI SAITO
a I Name:
Nippon Signal Company Limited
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:
Tochigi, Japan
Date of Birth:
30 April, 1959
Country of Birth
Japan
ID in applicant’s
Country:
N/A
Passport number:
TR9354389
Passport issue
Date:
19 October, 2017
Passport validity date:
19 October, 2027
Passport Issuing authority:
Ministry of Foreign Affairs Japan
Visa number:
A1135394
Visa issue date:
12 June, 2019
Visa Category:
A3
Visa validity date:
11 June, 2023
Visa issuing authority :
Embassy of The People’s Republic of Bangladesh Tokyo, Japan
Date of
application for
visa extension
N/A
Duration of stay in Bangladesh according to
visa status:
As Required
Place of visa issue
From:
Tokyo, Japan
Land phone
Number:
E-mail address:
Cell phone
number:
01317902150
Date of first
arrival in
Bangladesh:
20 June, 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:
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:
WPN-02Jul2019-00001
2 (Two) years
Validity date of
Work
Permit:
19 June 2021
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:
N/A
Road-Park, House-25, Apt-A4, Baridhara, Dhaka-1212, Bangladesh
Resident address in Bangladesh:
Manager
2. Your designation in your office:
Graduation in Mechanical Engineering
3. Educational Qualification and institution’s name:
Ibaraki University
Nippon Signal Company Limited
4. Employment History (in Bangladesh & Abroad):
In Bangladesh from 20 June 2019 to Present;
In Japan Sub-Manager for JR EAST MECHATRONICS CO., LTD, July -2007 to June - 2011
In Japan Manager NIPPON SIGNAL July-2011 to till date
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
Passport
Number
Relation With You
NAME: TAKESHI SAITO
SIGN:
DATE: