STUDENT’s CHARACTER VERIFICATION FORM

Temporary Security Clearance of Pakistani Nationals Passport Size

Photograph x 4
(Required in 04 copies) (01 at each form)
Attested from back
*All columns to be filled in Block Letters

1. Student Name________________________CNIC No__________________ (attach copy)

2. Father’s Name______________________ CNIC No__________________ (attach copy)
3. Date of Birth/age______________________ 4. Gender_________________________
5. University Name______________________ 6. Technology/Semester________________
7. Native Police Station_______________________________________________________
8. Present Address (with student mobile No)______________________________________
________________________________________________________________________
9. Permanent Address (with parents / guardian mobile No)___________________________
________________________________________________________________________
10. Residential Address during last 05 years_______________________________________
11. Name and address of 02 responsible persons who know the individual (not family
members)
(a) __________________________________________________________________
(b) __________________________________________________________________

12. It is hereby certify that all information given above are true to the best of my knowledge.
13. I hereby declare that I shall be abide by the rules / regulations of PAC during my entire
stay at Kamra. In case of violation of rules internship will be terminated immediately with
intimation to sponsoring education institute,

Date________________ (Signature of Student)

Remarks by Civil Police

VRC No____________________________________ Dated__________________________

Date_______________ (Sign & Seal Stamp of DPO)

COUNTER SIGN BY UNIVERSITY WITH STAMP

14. It is certified that above mentioned particulars are correct and the character of
student is above board.