Application For Police Clearance Certificate (Page 2 of 3) in pdf

Application For Police Clearance Certificate Page 2

15. Person authorized by the applicant who are in foreign to handover the application.

Mother

Father

Wife

Husband

Brother

Sister

Other

Name : ………………….………………………………………………………………………………………………

NIC / Passport No : …………………………………………………………

16. Indicate address of the High Commission/Embassy/Consulate to which the certificate should be

addressed to:

17. Indicate the address the police clearance certificate should be posted to:

18. Telephone Number in Sri Lanka :……………………………………

19. Email Address: …………………………………………………….

………………………………..

…………………………………………..

Date

Signature of Applicant

For office use only

Date

: ……………………………

Reference Number : ……………………………

Police Station

Date Sent

Date Returned

Remarks

SIS

CID

TID

Dept. Of Registration of

Persons (NIC)

BR Number

: ……………………………….

Date of Issue : ……………………………….

Manner of dispatch

Posted

Page: 2 of 3

Application For Police Clearance Certificate Page 2