Police Clearance Certificate Application Form PCC Download Free PDF
APPLICATION FOR POLICE CLERANCE CERTIFICATE BY AN INDIAN PASSPORT HOLDER
- SURNAME, NAME: Name of the applicant with aliases if any (IN BLOCK LETTER)
- Father/Husband’s Name
- Present Address (to be verified where stayed for more than one year)
Telephone No. Local Police Station Period of staying in Mumbai
- Particulars of the places (with period of residence) where you have resided during proceeding years since birth Since.
- Information of NAME
- Date of Birth
Place of Birth
- Educational Qualification showing places of education with years in School Collages
- Present Occupation Service with all particulars
- Reasons for obtaining Police Clearance Certificate for which Country
- Particulars of Passport
Date of Issue
Place of Issue
- Have you ever been arrested Prosecuted/Convicted/Detained?
If so, give particulars
- Have you ever taken active part in Politics? If so, give particulars.
- Identification Mark
- 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
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
Police Clearance Certificate No.
Date of Issue
Seal of the sinning Authority