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Application for Police Clearance

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					                                                                                                                          Annex 23B:
                                                               APPLICATION FOR A POLICE
                                                                CLEARANCE CERTIFICATE




SURNAME

*MAIDEN NAME

GIVEN NAMES


DATE OF BIRTH (YR/MTH/DAY)

PLACE OF BIRTH

SOUTH AFRICAN ID NO


LAST RESIDENTIAL
ADDRESS IN RSA

                                                                                                                              CODE

TEL OF ABOVE (CODE + NO)


LAST BUSINESS/
EMPLOYER’S ADDRESS IN RSA

                                                                                                                              CODE

TEL OF ABOVE (CODE + NO)


MAILING ADDRESS
IN COUNTRY OF

APPLICATION                                                                                                                   CODE

TEL OF ABOVE (CODE + NO)

E-MAIL ADDRESS

 *If Applicable
        SIGNATURE:                                                                             DATE:


 Note:
    This form is not a prescribed form from SAPS. It has been developed by the Department of Foreign Affairs to assist applicants.
    Attach full set of fingerprints, copy of ID document/passport, ZAR59-00 banker’s draft, money order or proof of electronic payment to
     the National Commissioner of the South African Police Service.
    Send to: Criminal Record Centre, 1st Floor, Room 14, Botongo Plaza West, 271 Schoeman Street, Pretoria, 0001, Republic of South
     Africa.
    If authentication by Department of Foreign Affairs is needed, include:
          Cover letter to SAPS - Criminal Record Centre explaining arrangements made; and
          Cover letter to the Department of Foreign Affairs - Legalisation Section indicating country in which certificate will be used.

				
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