Police Clearance Certificate Form

POLICE CLEARANCE CERTIFICATE APPLICATION FORM

To,

The Superintendent of Police,
District Police Office,
_________, _________.

Subject: Application for issuance of PCC

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            :     _________
Sex                      :    _________
Previous Name        :    _________
Date of Birth             :    _________
Occupation            :    _________
Father (Full Name)        :    _________
Mother (Full Name)        :    _________
Spouse (Full Name)        :    _________
Permanent Address        :    _________.
Present Address        :    House _________.
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 _________ and have not been involved in any criminal case in _________ and that there is no criminal case pending against me in the Court of Law.

 

___________________

(Signature of Applicant

Date

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