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

Application Form For Police Clearance Certificate Page 2

10.

Contact Telephone No.

Mobile no.: _____________ Residence: ______________ Business: __________________

E-mail Address: __________________________________________________________

11.

Have you ever been convicted by any court in India or abroad? YES/NO

12.

Is there any Police case pending against you in India or abroad? YES/NO

13.

Have you received any financial help from the government of India/State Government

or any other institute or organization in India in connection with your visit to UK? If Yes,

please furnish details.

14.

Have you ever served under the Central/State Government of India? If yes, have you

resigned from your service? (If yes, please attach copy of acceptance letter)

15.

FOR NON-INDIAN APPLICANTS:

Place of residence (with full postal addresses) whilst in India, with dates

SI. No.

Address where stayed

From

16.

Purpose of this application (Delete whichever not applicable):

(i)

Wishing to proceed to ______________________________________(country)

(ii)

For study in (subject) ________________________________________

For permanent settlement as an immigrant YES/NO

(iii)

(please strike off which is not applicable)

For seeking employment

YES/NO

(iv)

(please strike off which is not applicable)

(v)

For any other purpose (state the details)________________________________

I solemnly declare that the information given above is correct and nothing has been concealed

and I am aware that it is an offence to knowingly furnish false information or suppress material

information.

Date:___________________________

Signature: _________________________________

Name:

Application Form For Police Clearance Certificate Page 2