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Security Clearance
Form-2
(To be filled by the applicant)
Reference:
Subject: Personal Information.
Please find the information furnished here under for your ready reference.
ATSUSHI TERADA
A. Name:
SUMMIT POWER LIMITED
Male
B. Sex: M C. Name of Company/Firm:
Nationality
Japanese
2nd Nationality
(In the case of dual citizenship,
mention
the name)
N/A
Place of Birth:
Kanagawa
Date of Birth:
26 May 1984
Country of Birth
Japan
ID in applicant’s
Country:
N/A
Passport number:
TR6494447
Passport issue
Date:
17-August-2016
Passport validity date:
17-August-2026
Passport Issuing authority:
Ministry of Foreign Affairs
Visa number:
A 2445716
Visa issue date:
23-May-2023
Visa Category:
E
Visa validity date:
23-August-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:
90 days
Place of visa issue
From:
Tokyo, Japan
Land phone
Number:
N/A
E-mail address:
atsushi.terada@summit-centre.com
Cell phone
number:
+8801321160194
Date of first
arrival in
Bangladesh:
01-October-2021
Name of the Immigration checkpoint
While
Arriving first time
in
Bangladesh:
Hazrat Shahjalal International Airport
Date of last visit in Bangladesh:
30-May-2023
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
Validity date of
Work
Permit:
29-May-2024
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:
N/A
Are you engaged
With any other
occupation in Bangladesh:
No
If applicant
Engaged
with other job
then
clarify of that:
N/A
Park Road, House-34/36, Apartment-A14, Baridhara, Dhaka, 1212, Bangladesh.
Resident address in Bangladesh:
Technical Manager
2. Your designation in your office:
Master’s Program
3. Educational Qualification and institution’s name:
Electrical Engineering and Information Systems
Graduate School of Engineering
4. Employment History (in Bangladesh & Abroad):
Chubu Electric Power Co., Inc.
-Member 2015-2016
-Operator 2013-2015
-Engineer 2010-2012
JERA Co., Inc.
-Manager 2020-Present
-Assistant Manager 2016-2020
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: ATSUSHI TERADA
SIGN:
DATE: