Application Form For Police Clearance Certificate printable pdf download

Application Form For Police Clearance Certificate

Embassy of India

Stockholm

Application Form for Police Clearance Certificate

(Please Use Typewriting or Black Ink Pen with Clear Handwriting and Block Letters)

Write names in extended forms and not initials

Name of Applicant :

_____________________________________________

Previous or Maiden Name :

_____________________________________________

Father/Husband’s Name :

_____________________________________________

Date of Birth :

____________________ Place of Birth : ______________________

Present Nationality :

_____________________________________________

Date of acquisition of foreign nationality, if applicable : ________________________

Passport No. :

____________________ Place of Issue : ______________________

Date of Issue :

____________________ Passport Validity : ___________________

Permanent Address :

__________________________________________________

Present Address :

__________________________________________________

Contact Particulars :

Office/Home :

___________________ Mobile :

________________________

Fax : _____________________________ E-mail :

________________________

Purpose for which PCC is required : ________________________________________

Declaration :

I ___________________________________, presently __________________ national

and holder of Passport No. ____________________ dated ____________________

hereby declare that there is no criminal or civil case pending against me in any Court of

India.

…………………………………………….

……………………………….

(Date & Place)

(Signature)

Application Form For Police Clearance Certificate