Documents to be attached :

1. Four passport size photographs.

2. Two residential proofs i.e electricity bill/Index
papers/Municaipal tax receipt/Leave Licence agreement/.
3. Photo copy of School Leaving Certificate.
4. Photo Copy of valid Passport.
5. Rs. 100/- Cash.

Application Form for getting

Police Clearance Certificate
1.

Name in full (Block Letters)

Surname first.

2.

Present Address in full.

3.

Home address in full i.e.

Village/Thane/Taluka/ Tahsil & District
or House no. Lane/Street/Road and Town
with Pin Code.

4.

Particulars of the place with the period of

residence where you have resided during
preceeding years since birth.

Information

Father

Mother

Husband
/Wife

Brother

Sister

5.

Date of Birth

6.

Place of Birth

Name

Address

Present Address

Educational Qualification showing places of education with years in School/College.

7.
Name and Address of
Institute

Date of Joining / Date of Examination Passed

Leaving

8.

Have you ever been arrested/ prosecuted/

detained/ fined/convicted? If so, give case
details.

9.

Have you ever taken active part in politics ? If so

give particulars.

10. Present occupation / Service with all

Particulars.
11. Reason for obtaining character certificate and to
whom it is required . / which country.
12. Identification Marks
13.

14.

Name, address and signature of two references of the persons of your locality, to
whom you are known.
Reference 1

Reference 2

I certify that above mentioned information is correct and complete to the best of my
knowledge.
Signature of Applicant