CLEARANCE_CERTIFICATE_APPLICATION_FORM by sraichauhan

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									         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)

								
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