OA0000005337117

Part 1 Personal Information Part 3 Travel Documents Passport No: Place of Issue: Date of Issue: Date of Expiry: Last Visa No.: Last Visa Issue Date: Place of Issue: Type of Visa: TZ1387565 11/11/2019 11/11/2029 08/11/2025 VOA251108/30 08/11/2025 Hazrat Shah Jalal International Airport VOA EMBASSY OF JAPAN INDONESIA Part 4 Payment Information Name of the Bank: Cheque/Bank Transfer/Chalan/Scroll No.: Date: Part 7 Document Check List Type of Visa Enrollment: New Visa Name of the Branch of Bank: Date of last visit to Bangladesh Part 5 New Visa Information Intended Number of Entries: Tentative Date of Arrival in Bangladesh: Purpose of Visit: MULTIPLE 15/01/2026 Specify Other Purpose: Duration of Proposed Stay in Bangladesh: 3 Month(s) EMPLOYMENT Part 2 Visa Information Payment Mode: Payment Currency: Part 6 Visa Office / Bangladesh High Commission Office Information Bangladesh High Commission: TOKYO JAPAN Recommendation from concern Ministry Authority Security Clearance / Security Certificate Father's / Husband's / Mother's Visa copy Passport Copy, Last Visa and Last Arrival Page Father's / Husband's / Mother's Passport copy N. O. C from Sri Lankan High Commission Bi-Lateral Agreement / Multilateral Agreement Trade license of the sponsoring Company Payment Slip Over stay Payment Slip Marriage Certificate Birth Certificate Work Permit Affidavit Photo Income Tax Certificate of the Company TIN TIN Certificate of the Company Others √ √ √ √ MARRIED Current Location: Last / Surname(as in the passport): Permanent Address: Contact no. at permanent address: Email: Address in Bangladesh: Date of Birth: Japan Place of Birth: Present Nationality: Nationality at Birth: Occupation: Marital Status: KOZO MATSUOKA 208-84 KOYA HITACHINAKA IBARAKI JAPAN 312-0002 00819051769810 k-matsuoka@niccachemical.com NICCA CHEMICAL CO., LTD. 23-1, 4-CHOME, BUNKYO, FUKUI-CITY, FUKUI 910- 8670 JAPAN 01996857561 09/02/1986 IBARAKI Japanese Japanese PRIVATE SERVICE Sex: Contact no. in Bangladesh: First Name(as in the passport): MALE Last / Surname on Visa: KOZO MATSUOKA First Name on Visa: Country of Birth: Japan