POLICE CLEARANCE CERTIFICATE FORM

To,

The _________ Police,
District Police Office,
_________, _________.

Subject: Application for Issuance of PCC (POLICE CLEARANCE CERTIFICATE)

Sir,

It is requested that a Police Clearance Certificate may be issued to me for _________ purpose. My personal particulars are as follows:

Full Name            :     _________

Sex                      :    _________

Previous Name        :    _________

Date of Birth             :    _________

Occupation            :    _________

Father (Full Name)        :    _________

Mother (Full Name)        :    _________

Spouse (Full Name)        :    _________

Permanent Address        :    _________.

Present Address        :    House _________.

Residing at current address since: _________

Passport No.: _________ Date of Issue: _________ Valid till: _________

Passport issued by: Regional Passport Officer _________

Reason for Applying PCC: _________

It is further stated that I am a citizen of _________ and have not been involved in any criminal case in _________ and that there is no criminal case pending against me in the Court of Law.

___________________
(Signature of Applicant)
_________________

(Date)