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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.
SHINJI TANAKA
a I Name:
Nippon Koei Bangladesh Ltd.
Male
b I Sex: M C. Name of company/firm C.
Nationality
Japanese
2nd Nationality
(In case of dual citizenship,
mention
the name)
N/A
Place of Birth:
Fukuoka
Date of Birth:
10th June 1965
Country of Birth
Japan
ID in applicant’s
Country:
N/A
Passport number:
MJ1002990
Passport issue
Date:
10th February 2020
Passport validity date:
10th February 2025
Passport Issuing authority:
Ministry of Foreign Affairs
Visa number:
A 2445550
Visa issue date:
15th May 2023
Visa Category:
E
Visa validity date:
15th 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:
tanaka-sn@n-koei.jp
Cell phone
number:
01701-671722
Date of first
arrival in
Bangladesh:
6th March, 2021
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:
20th 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:
WPN-27May2023-00007
2 Years
Validity date of
Work
Permit:
19th May 2025
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 5-A & B, Concord Baksh Tower Plot #11-A, Road #48, Block #CWN(A), Gulshan-2, Dhaka 1212
Gulshan-2, Dhaka 1212
Resident address in Bangladesh:
GENERAL MANAGER
2. Your designation in your office:
Bachelor in Engineering
3. Educational Qualification and institution’s name:
SAITAMA UNIVERSITY, FACULTY OF ENGINEERING, 1994
4. Employment History (in Bangladesh & Abroad):
NIPPON KOEI, ASSOCIATE DIRECTOR, From 1994 To 2022
NIPPON KOEI BANGLADEH, GENERAL MANAGER 2022-Continuing
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: SHINJI TANAKA
SIGN:
DATE: