Scribd
Upload
193 views2 pages

Police Clearance Certificate Application

The document is a police clearance certificate (PCC) application form requesting the issuance of a PCC for visa/immigration purposes. It contains fields for the applicant to provide personal details like name, date of birth, addresses, passport information, and a statement that they have not been involved in any criminal cases. The applicant must sign and date the form and can attach any additional documents.

Uploaded by

Mayank Kukreti
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
193 views2 pages

Police Clearance Certificate Application

The document is a police clearance certificate (PCC) application form requesting the issuance of a PCC for visa/immigration purposes. It contains fields for the applicant to provide personal details like name, date of birth, addresses, passport information, and a statement that they have not been involved in any criminal cases. The applicant must sign and date the form and can attach any additional documents.

Uploaded by

Mayank Kukreti
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

POLICE CLEARANCE CERTIFICATE APPLICATION FORM

To
The Superintendent of Police,
District Police Office,
Panchkula.
Applicant must paste
one photograph 35mm
Subject: Application for issuance of PCC x 35mm here with half
the signature on the
photograph and half

Sir,
It is requested that a Police Clearance Certificate
may be issued to me for visa/immigration purpose. My
personal particulars are as follows:
Full Name (Expanded Initials)______________________________________________
Sex ___________________________________________________________________
Previous Name (in case the name has been changed) _____________________________________
Date of Birth____________________________________________________________
Occupation _____________________________________________________________
Father (Full Name) _______________________________________________________
Mother (Full Name) ______________________________________________________
Spouse (Full Name) ______________________________________________________
Permanent Address _______________________________________________________
_______________________________________________________________________
Present Address _________________________________________________________
Residing at current address since ____________________________________________
Passport No. _________________ Date of issue __________ Valid till______________
Passport issued by: Regional Passport Officer __________________________________
Country for which Visa/Immigration has been applied ___________________________
It is further stated that I am a citizen of India and have not been involved in any
criminal case in India and that there is no criminal case pending against me in the Court
of Law.
_____________________
(Signature of Applicant)
_________________
(Date)
Documents attached: ______________________________________________________
_______________________________________________________________________

You might also like