CONSULATE GENERAL OF INDIA

LEVEL 1, 265 CASTLEREAGH STREET SYDNEY, NSW 2000,

AUSTRALIA
00-61-2-92232702, https://cgisydney.gov.in/

APPLICATION FORM FOR POLICE CLEARANCE Generated On: 29/01/2020,

CERTIFICATE 2:19:53 am

SERVICE REQUIRED
Application Reference Number 20-2000289222
EMPLOYMENT VISA/WORK
Purpose of PCC
PERMIT
Country for which PCC is
AUSTRALIA
required
PASSPORT DETAILS
Passport Number U0145581
Date of Issue (DD/MM/YYYY) 01/07/2019
Date of Expiry (DD/MM/YYYY) 30/06/2029
Place of Issue SYDNEY
File Number AUSS01577719

Paste your
APPLICANT DETAILS
unsigned
recent color
Applicant's Name KANAV MANCHANDA
photograph
Date of Birth (DD/MM/YYYY) 28/10/1991
Size 2"X2"
Place of Birth (Village/Town/City) SYDNEY
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN CUIPM7439P
Voter Id
Educational Qualification GRADUATE AND ABOVE
Employment Type NOT EMPLOYED
Organisation name
Aadhaar Number 977102486749

Note: Please paste your unsigned recent color photograph Size 2"X2" and Signature/Left Hand Thumb
Impression in the box provided above.

FAMILY DETAILS
Father's Name SUNIL MANCHANDA
Mother's Name SHOBHNA RANI
Legal Guardian's Name
Spouse's Name
PERMANENT ADDRESS IN INDIA
7 NEW VIVEKANAND PARK, MAQSUDAN,
Address DIVISION NO 1
JALANDHAR, PUNJAB
PIN 144008
Mobile/Tel No. 9417190651
E-mail KANAVMANCHANDA@HOTMAIL.COM
PRESENT ADDRESS IN COUNTRY OF DOMICILE
254A FLUSHCOMBE ROAD,, BLACKTOWN, NSW,
Address 2148
, AUSTRALIA
Mobile/Tel No. 061424424004
OTHER DETAILS
Have you ever been charged with criminal
proceedings or is any arrest warrant/summon NO
pending before a court in India?
SELF DECLARATION
I owe allegiance to the sovereignty, unity and integrity of India, and have not voluntarily acquired citizenship
or travel document of any other country. I have not surrendered or been deprived of the citizenship of India
and I affirm that the information given by me in this form and the enclosures is true and I am solely
responsible for its accuracy, and I am liable to be penalized or prosecuted if found otherwise. I am aware
that under the Passports Act, 1967 it is a criminal offence to furnish any false information or to suppress any
material information with a view to obtaining passport or travel document.

BLACKTOWN,
Place Signature/Left Hand Thumb Impression of
NSW
Applicant
Date 29/01/2020