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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.
MOHAMAD RIZWAN BIN SHAHABUDDIN
a I Name:
MIURA BANGLADESH CO., LTD.
Male
b I Sex: M C. Name of Company/firm
Nationality
Malaysian
2nd Nationality
(In case of dual citizenship,
mention
the name)
N/A
Place of Birth:
Johor, Malaysia
Date of Birth:
10th February 1989
Country of Birth
Malaysia
ID in applicant’s
Country:
N/A
Passport number:
A 54458651
Passport issue
Date:
24th June 2021
Passport validity date:
24th December 2026
Passport Issuing authority:
Putrajaya
Visa number:
060003052302387
Visa issue date:
29th May 2023
Visa Category:
E
Visa validity date:
28th September 2023
Visa issuing authority:
Bangladesh High Commission, Kuala Lumpur, Malaysia
Date of
application for visa extension
N/A
Duration of stay in Bangladesh according to
visa status:
90 Days
Place of visa issue
From:
Kuala Lumpur, Malaysia
Land phone
Number:
N/A
E-mail address:
mohamad_rizwan@miuraz.co.jp
Cell phone
number:
01847123125
Date of first
arrival in
Bangladesh:
4th November 2021
Name of the Immigration checkpoint
While
Arriving first time
in
Bangladesh:
Hazrat Shahjalal International Airport
Date of last visit in Bangladesh:
4th June 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:
WPN-06Jun2023-00011
1 year
Validity date of
Work
Permit:
3rd June 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:
No
Are you engaged
With any other
occupation in Bangladesh:
No
If applicant
Engaged
with other job
then
clarify of that:
No
Unit D2, House No 9, Park Road, Baridhara, Dhaka.
Resident address in Bangladesh:
Senior Manager
2. Your designation in your office:
Bachelor in Applied Quantum Physics and Nuclear Engineering
3. Educational Qualification and institution’s name:
Kyushu University, Japan
4. Employment History (in Bangladesh & Abroad):
Miura Singapore Co Pte. Ltd (Bangladesh Liaison Office)-
-20 October 2018 to 31 December 2022-Country Manager
Miura Singapore Co Pte. Ltd.
-1 August 2017 to 19 October 2018-Service Engineer
Miura Co., Ltd. Matsuyama Sales Office
-1 April 2015 to 31 July 2017-Maintenance Department
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: MOHAMAD RIZWAN BIN SHAHABUDDIN
SIGN:
DATE: