Police Clearance Certificate Application Form PCC Download Free PDF

Police Clearance Certificate Application Form PCC Download Free PDF

APPLICATION FOR POLICE CLERANCE CERTIFICATE BY AN INDIAN PASSPORT HOLDER

  1. SURNAME, NAME: Name of the applicant with aliases if any (IN BLOCK LETTER)
  2. Father/Husband’s Name
  3. Present Address (to be verified where stayed for more than one year)
    Telephone No. Local Police Station Period of staying in Mumbai
  4. Particulars of the places (with period of residence) where you have resided during proceeding years since birth Since.
  5. Information of NAME
    OCCUPATION
    PRESENT ADDRESS
    FATHER
    MOTHER
    HUSBAND WIFE
    BROTHER
    SISTER
  6. Date of Birth
    Place of Birth
  7. Educational Qualification showing places of education with years in School Collages
  8. Present Occupation Service with all particulars
  9. Reasons for obtaining Police Clearance Certificate for which Country
  10. Particulars of Passport
    Passport No
    Date of Issue
    Place of Issue
    Valid Date
  11. Have you ever been arrested Prosecuted/Convicted/Detained?
    If so, give particulars
  12. Have you ever taken active part in Politics? If so, give particulars.
  13. Identification Mark
  14. Name and addresses of two responsible persons of your locality to whom you are known

I certify that the forgoing information is correct and complete to the best of my
knowledge and belief

Place

Date

Note:
Application should submit the photocopies of the following documents duly attested.
by Gazzeted Officer or First-Class Magistrate

(Signature of the Applicant)

Attested Xerox copy of Valid Passport & passport size photographs
Attested Xerox copy of Residential Proof In addition to passport) 1.e. Ration Card

Societies Letter Electricity Bill Telephone Bill, etc
Letter instructions of the Embassy demanding the Police Clearance Certificate
A Demand Draft of Rs. 100-m favour of “THE COMMISSIONER OF POLICE
BRIHAN MUMBAI as a charge for verification to be paid to the Government

FOR OFFICE USE ONLY

Verified by

Police Clearance Certificate No.

PSI

Date of Issue

Seal of the sinning Authority