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 Indian 2 nd Nationality
(In case of dual
citizenship,
mention
the name)
No
Place of Birth: Gorakhpur, Uttar
Pradesh, India
Date of Birth: 15 October, 1986
Country of
Birth
India ID in applicant’s
Country:
N/A
Passport
number:
Z4167757 Passport issue
Date:
14 November, 2017
Passport
validity date:
13 November, 2027 Passport Issuing
authority:
Regional Passport Office,
Lucknow
Visa number: 091011121955917 Visa issue date: 26 December, 2019
Visa Category: Employment Visa validity date: 25 December, 2019
Visa issuing
authority :
Bangladesh High
Commission, New
Delhi, India
Date of
application for
visa extension
N/A
Duration of
stay in
Bangladesh
according to
visa status:
As Required Place of visa issue
From:
New Delhi, India
Land phone E-mail address:
ROHIT NANDAN SINGH
Male
Nippon Signal Company Limited
Number:
Cell phone
number:
+8801818-042578 Date of first
arrival in
Bangladesh:
04 January, 2020
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:
WPN-09Jan2020-00008
11 months 29 days
Validity date
of
Work
Permit:
03 January 2021
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):
CP-7 project office, Block I, Sector 16,
Road: Sonargoan Janapath, Diabari, Uttara, Dhaka-1230, Bangladesh
Interface Testing & Commissioning Manager
(Signalling)
Diploma in Electrical Engineering
Directorate of Board Technical Education, Uttar Pradesh
Nippon Signal Company Limited
In Bangladesh from 04 January, 2020 to Present;
In QATAR Thales Gulf. (Technical Team Lead) February, 2018 to December,
2019.
In India Nippon Signal Co, Ltd. (Dy. Manager) From June, 2015 February, 2018
In India KEC INTERNATIONAL LTD. (Assistant Manager) From July 2011 to
June, 2015.
In India ANSALDO STS INDIA PVT. LTD. NOIDA (Project Engineer) From
December, 2009 to July, 2011.
In India ANSALDO STS INDIA PVT.LTD. NOIDA (Site Engineer) From April,
2009 to December, 2009.
In India ANSALDO STS INDIA PVT.LTD. NOIDA (Site Supervisor) From
January, 2007 to March, 2009
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: ROHIT NANDAN SINGH
SIGN:
DATE: