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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: 17 April, 1969
Country of
Birth
Japan ID in applicant’s
Country:
N/A
Passport
number:
TR2009114 Passport issue
Date:
9 July, 2014
Passport
validity date:
9 July, 2024 Passport Issuing
authority:
Ministry of Foreign Affairs, Japan
Visa number: Cons/2369/A3/18 Visa issue date: 17 August, 2018
Visa Category: Employment
Contract.
Visa validity date: 17 August, 2021
Visa issuing
authority:
Embassy of Peoples
Republic of
Bangladesh, Tokyo.
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.
YOSHIHIRO HOTTA
Male
International Manpower
Development Organization (IM)
Japan
Land phone
Number:
E-mail address:
Cell phone
number:
01730595730 Date of first
arrival in
Bangladesh:
23 September, 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:
Ref No: WPN-12Aug2021-00014
1 (One) year
Validity date
of
Work
Permit:
20 July 2020
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:
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):
Apartment # A4, 4 th Floor, Scenic Villa,
House # 23, Road # 6, Baridhara, Dhaka.
General Manager
Bachelor of Arts (Economics)
JOSAI UNIVERSITY. JAPAN
International Manpower
Development Organization (IM)
➢ In Bangladesh from 21 July, 2019 to Present;
Note: Duration of Corona Period he was outside of Bangladesh.
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: YOSHIHIRO HOTTA
SIGN:
DATE: