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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 Malaysia 2 nd Nationality
(In case of dual
citizenship,
mention
the name)
No
Place of Birth: KELANTAN Date of Birth: 1 January, 1983
Country of Birth Malaysia ID in applicant’s
Country:
830101036209
Passport
number:
A52091750 Passport issue
Date:
26 November, 2018
Passport validity
date:
24 January, 2024 Passport Issuing
authority:
UTC Kuala Lumpur
Visa number: 06000304220554 Visa issue date: 4 April, 2022
Visa Category: Employment Visa validity date: 30 July, 2022
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:
E-mail address: nik@secbangla.com
NIK MOHD HAFIZ BIN NIK MUSTAFA
Male
Sanyo Engineering &
Construction Inc.
Cell phone
number:
01796-770136 Date of first
arrival in
Bangladesh:
09 May, 2022
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:
09 May, 2022
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-09May2022-00011
(1 year)
Validity date of
Work
Permit:
08 May, 2023
Please mentioned
the date,
if you have
applied for
extension of your
work permit:
N/A
Do you pay tax
to Bangladesh
Government
N/A 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:
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):
3 rd Floor, Plot# 356, Road# 05, Mirpur DOHS,
Dhaka 1216.
Project Manager
Bachelor of Engineering
(Electrical)
UNIVERSITI TEKNOLOGI MALAYSIA
From 2007 and 2013 he had been worked in Bina Puri Sdn. Bhd as a position of “M & E
Engineer” in Kuala Lumpur.
From 2013 to 2014 he had been worked with in Ho Hup Construction Co. Berhad as a
position of “M & E Engineer” in Baghdad.
From 2014 to 2014 as a position of “Assistant Resident Engineer” he worked in
Minconsult Sdn Bhd.
From 2015 to 2017 as the position of “Assistant Resident Engineer” he had worked in
AECOM
From 2017 to 2018 he worked in Siemen (M) Sdn Bhd as a position of “Liaison
Technical Engineer”
From 2018 to 2020 he worked in AECOM as a position of “Assistant Resident Engineer-
M&E”
From 2020 to 2021 he worked with MEG Consult Sdn Bhd as a position of “Resident
Engineer- M&E”
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: NIK MOHD HAFIZ BIN NIK MUSTAFA
SIGNATURE:
DATE: 07 May 2022