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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.
MASARU UZUKA
a I Name:
TAMURAKOMA & CO., LTD.
Male
b I Sex: M C. Name of company/firm C.
Nationality
Japanese
2nd 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
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
NAVANA SAMBILAN, Apt, No: 4-B, House #3,
Resident address in Bangladesh:
Road # 23, Block# B, Banani Dhaka – 1213.
Assistant Country Manager
2. Your designation in your office:
Bachelor of Economics
3. Educational Qualification and institution’s name:
HOSEI UNIVERSITY.
TAMURAKOMA & CO., LTD.
4. Employment History (in Bangladesh & Abroad):
In Bangladesh from 8th June 2022;
In Japan from 2000 to 2022 TAMURAKOMA & CO., LTD as a “Manager”
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: MASARU UZUKA
SIGN:
DATE: