Scribd
Upload
336 views1 page

Police Clearance Certificate Application

The document is a police clearance certificate application form. It requests the issuance of a police clearance certificate for visa/immigration purposes. It collects personal information such as the applicant's full name, sex, date of birth, occupation, addresses, passport details, and a statement that the applicant has not been involved in any criminal cases or have any pending criminal cases. The applicant must sign and date the form and attach a photograph.

Uploaded by

yasservk
Copyright
© Attribution Non-Commercial (BY-NC)
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
336 views1 page

Police Clearance Certificate Application

The document is a police clearance certificate application form. It requests the issuance of a police clearance certificate for visa/immigration purposes. It collects personal information such as the applicant's full name, sex, date of birth, occupation, addresses, passport details, and a statement that the applicant has not been involved in any criminal cases or have any pending criminal cases. The applicant must sign and date the form and attach a photograph.

Uploaded by

yasservk
Copyright
© Attribution Non-Commercial (BY-NC)
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,
_________________.
Applicant must paste
one photograph 35mm
Subject: Application for issuance of PCC x 35mm here with half
the signature on the
photograph and half on
Sir, the application
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)

You might also like