POLICE CLEARANCE CERTIFICATE APPLICATION FORM
To The Superintendent of Police, District Police Office, Ambala.
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 (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)
Applicant must paste one photograph 35mm x 35mm here with half
the signature on the photograph and half on the application.
