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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
Nationality Japanese 2 nd Nationality
(In case of dual
citizenship,
mention
the name)
N/A
Place of Birth: Kanagawa Date of Birth: 17 th December 1973
Country of
Birth
Japan ID in applicant’s
Country:
Passport
number:
TZ2063243 Passport issue
Date:
7 th July 2021
Passport
validity date:
7 th July 2031 Passport Issuing
authority:
Embassy of Japan in Sri Lanka
Visa number: A 3760683 Visa issue date: 28 th May 2024
Visa Category: E Visa validity date: 10 th September 2024
Visa issuing
Authority:
Bangladesh
Embassy, Colombo,
Sri Lanka.
Date of
application for visa
extension
N/A
MASAKAZU SOTA
Male Taisei corporation.
Duration of
stay in
Bangladesh
according to
visa status:
As Required
Place of visa issue
From: Dhaka
Land phone
Number:
E-mail address: sotasota@ce.taisei.co.jp
Cell phone
number: 01787657784
Date of first
arrival in
Bangladesh:
29 th November, 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: 11 th June 2024
Name of the
immigration
cheek point
while
Arriving last
time
In
Bangladesh
Do
Date of enrolment
In foreigner’s
Registration office
Not Applicable
Do you
possess
Any
Work permit?
Yes Number &
duration of
work permit:
WPN-12Jun2024-00017
1 year
Validity date
of
Work
Permit:
10 th June 2025 Please mentioned
the date,
if you have
applied for
extension of your
work permit:
Not Applicable
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:
Not Applicable
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:
Catharsis Tower, 10th Floor, House No.133, Road No.
12, Block-E, Banani, Banani
Manager
Graduate
Chuo University, Faculty of Science and Engineering
General Manager- Taisei Corporation
(Sri Lanka)
Attached with Passport
No.
7. Is your spouse(S) residing with you in Bangladesh? If yes please furnish:
SL
No
Name Passport Number Relation With You
NAME: MASAKAZU SOTA
SIGN:
DATE: 20 th Aug 2024