ZRP.-80M-$.5-65 Application for Police Certificate (Tobe completed in block ieters) FORM 137 FOR OFFICE USE ONLY Seri Date Received CLD. H.Q, Ref CBLCBD. ‘Sumame of applicant Chistian names Maiden nazne Previous married names Date of birth Town of birth Country of birth Date of first entry into Zimbabwe Place of first entry into Zimbabwe Present residential address ‘Why are you applying for a Police Certificate? ‘Which country is your intended destination? ‘What wil! be your address thereat? ‘What is your proposed date of departure? = ‘Ta which address should the completed Certificate be sent? | Have you been convicted in Zinhabwe of any offence? If so give details. IMPORTANT: Please read and comply with the instructions on the back of this form before signing, $4 Zinbabe Revenis ‘Stamp ote wBndhere