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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, Japan Date of Birth: 16 February, 1975
Country of
Birth
Japan ID in applicant’s
Country:
N/A
Passport
number:
TT1879605 Passport issue
Date:
25 October, 2021
Passport
validity date:
25 October, 2031 Passport Issuing
authority:
Ministry of Foreign Affairs Japan
Visa number: A2343360 Visa issue date: 09 May, 2022
Visa Category: E Visa validity date: 09 August, 2022
Visa issuing
authority:
Embassy of The
People’s Republic
of Bangladesh
Tokyo, Japan
Date of
application for
visa extension
04 July 2022
Duration of
stay in
Bangladesh
according to
visa status:
As Required Place of visa issue
From:
Tokyo, Japan
MASARU UZUKA
Male
TAMURAKOMA & CO., LTD.
Land phone
Number:
E-mail address: masaru_uzuka@tamurakoma.co.jp
Cell phone
number:
01300309939 Date of first
arrival in
Bangladesh:
08 June 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:
08 June 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-09Jun2022-00025
1 (One) year
Validity date
of
Work
Permit:
07 June 2023 Please mentioned
the date,
if you have
applied for
extension of your
work permit:
N/A
Do you pay tax
to Bangladesh
Government
No 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):
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
NAVANA SAMBILAN, Apt, No: 4-B, House #3,
Road # 23, Block# B, Banani Dhaka – 1213.
Assistant Country Manager
Bachelor of Economics
HOSEI UNIVERSITY.
TAMURAKOMA & CO., LTD.
In Bangladesh from 8 th June 2022;
In Japan from 2000 to 2022 TAMURAKOMA & CO., LTD as a “Manager”
7. Is your spouse(S) residing with you in Bangladesh? If yes please furnish:
SL
No
Name Passport
Number
Relation With You
NAME: MASARU UZUKA
SIGN:
DATE: