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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.
SHOTA WADA
a I Name:
Male
International Manpower Development Organization (IM) Japan
b I Sex: M C. Name of Company/firm
Nationality
Japanese
2nd Nationality
(In case of dual citizenship,
mention
the name)
N/A
Place of Birth:
KANAGAWA
Date of Birth:
13th September 1995
Country of Birth
JAPAN
ID in applicant’s
Country:
Passport number:
TT1274793
Passport issue
Date:
11th May 2020
Passport validity date:
11th May 2030
Passport Issuing authority:
Ministry of Foreign Affairs
Visa number:
A 3747724
Visa issue date:
27th February 2025
Visa Category:
A3
Visa validity date:
27th February 2027
Visa issuing authority:
Tokyo, Japan.
Date of
application for visa extension
Duration of stay in Bangladesh according to
visa status:
2 years
Place of visa issue
From:
Tokyo, Japan
Land phone
Number:
E-mail address:
wada.s@imm.or.jp
Cell phone
number:
013 26708919
Date of first
arrival in
Bangladesh:
3rd March 2025
Name of the Immigration checkpoint
While
Arriving first time
in
Bangladesh:
Hazrat Shahjalal International Airport.
Date of last visit in Bangladesh:
3rd March 2025
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
WPN-06Mar2025-00029
Validity date of
Work
Permit:
2nd March 2026
Please mention
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 has 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:
No
Please fill-up current resident Address
Resident address in Bangladesh:
Overseas Co-Ordination Officer
2. Your designation in your office:
Bachelor of Regional Development Studies
3. Educational Qualification and institution’s name:
TOYO UNIVERSITY
Attached with Resume
4. Employment History (in Bangladesh & Abroad):
Attached with Passport
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: SHOTA WADA
SIGN:
DATE: