APPLICATION FORM FOR WORK PERMIT
(PLEASE TYPE or WRITE IN CAPITAL LETTERS IN BLUE OR BLACK INK)
I. Details of the applicant
1. Name as in passport/voter card
ISLAM MD MASHUKUL
Recent passport
2. Date of birth (dd/mm/yy) 3. Nationality 4. Sex: Male Female
size photo
31-12-1998 BANGLADESHI
5. Marital status: Married Single 6. Father’s name
MD ENAYET HOSSAIN
7. Occupation 8. Qualification Khan
HIGH SCHOOL
PRINTER
II. Identity Document Details
9. Passport/Voter Card No. 10. Place of issue 11. Date of issue (dd/mm/yy) 12. Valid till (dd/mm/yy)
AD3144557 BANGLADESH 12-2-2022 11-2-2032
13. Visa/Entry Permit No. 14. Date of Issue (dd/mm/yy) 15. Valid till (dd/mm/yy)
PMDRJ414497E9F88 7-10-2023 6-10-2024
III. Permanent Address 19. Contact no.
16. City/District 17. State 18. Pin code no.
0172710454
DHAKA BANGLADESH 1720
IV. Employment Details
20. Name of the employer/agency 21. Approved application ID no.
LORIANA BATCH 10GD2024P9
22. Job category 23. Work location/site 24. Dzongkhag
Ontario Canada
Declaration:
I hereby solemnly affirm and declare that all documents submitted by me for processing Work Permit are genuine
and truthful in all aspects. I understand that providing incomplete, false or misleading information will result in
rejection/cancellation of Work Permit. Furthermore, I also understand that I will be liable for prosecution by a court
of law and/or any fines/penalties under the Immigration Act of the Kingdom of Bhutan and other laws, rules and
regulations as may be applicable, for submission of false, fabricated or misleading information or for indulging in
any other activities other than the stated.
Place:
Loriana Batch
Date:
Signature of the Employer Signature of the applicant
For official use only
Approved/Rejected
Signature of approving officer:
