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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 .
a I Name:
b I Sex: M C. Name of company/firm C.
Nationality Japanese 2 nd Nationality
(In case of dual
citizenship,
mention
the name)
No
Place of Birth: Tokyo. Date of Birth: 19 February, 1987
Country of
Birth
Japan ID in applicant’s
Country:
N/A
Passport
number:
MU7052635 Passport issue
Date:
05 January, 2018
Passport
validity date:
05 January, 2023 Passport Issuing
authority:
Ministry of Foreign Affairs, Japan
Visa number: A 2340420 Visa issue date: 26 June, 2021
Visa Category: Employment Visa validity date: 26 September, 2021
Visa issuing
authority :
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 E-mail address: shiono-bn@n-koei.jp
BUNTARO SHIONO
Male
Nippon Koei Bangladesh Ltd.
Number:
Cell phone
number:
+88 01940-440011 Date of first
arrival in
Bangladesh:
28 March, 2018
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
Do you
possess
Any
Work permit?
Yes Number &
duration of
work permit:
WPN-13Jul2021-00019;
(1 Year)
Validity date
of
Work
Permit:
08 July, 2022
Please mentioned
the date,
if you have
applied for
extension of your
work permit:
N/A
Do you pay tax
to Bangladesh
Government
- 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
1. Resident address in Bangladesh:
2. Your designation in your office:
3. Educational Qualification and institution’s name:
4. Employment History (in Bangladesh & Abroad):
House # 30, Road No, 38, Ghulsan, Dhaka
General Manager
Bachelor of Arts in Foreign
Studies.
SOPHIA UNIVERSITY ( JOCHI DAIGAKU)
Nippon Koei Bangladesh Ltd.
In Japan Head Quarter from 2016 to Present; Related with strategic plan of
the organization, along with financial and engineering Consulting.
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: BUNTARO SHIONO
SIGN:
DATE: