China Police Clearance Certificate Application Form

Please Fill This Form With Black Pen 2020 Ver. 1.1

1. Which country ask you to provide Police Clearance Certificate?

☐ Australia ☐ Canada ☐ USA ☐ ___________

2. Why do you need a Police Clearance Certificate from China?

☐ Job ☐ Immigration ☐ Study ☐ ___________

3. Which Chinese city did you live/stay in?

☐ Beijing ☐ Shanghai ☐ Hangzhou ☐ ___________

4. What’s your Chinese employer’s name? or Website?

☐ Name in Chinese ____________________ ☐ Website ___________________________

5. Which period of your stay should the Police Clearance Certificate cover?

From YYYY/MM/DD ___________ To YYYY/MM/DD ___________

6. Which language do you need it to be translated into?

☐ English ☐ French ☐ Spanish ☐ ___________

7. What’s your address while you studed/worked in China?

☐ In Dorm ☐ Rented Outside (We prefer Chinese) _________________________

8. How many copies do you need?

☐1 ☐2 ☐3 ☐ ___________

9. Have you ever changed your nationality or name?

☐ Before ___________ ☐ Current ___________ ☐ Never

10. How did you find us?

☐ Google ☐ Yahoo ☐ Bing ☐ ___________

11. Your contact ways:

☐ Email ___________ ☐ Wechat ___________ ☐ Phone ___________

I hereby certify that all above information is true, all my documents attached in my email(s) are true copy of the original
documents, and I have personally read the following content before I sign my name.
1. Your service fee does not include shipment/courier fee.
2. Your service fee includes English translation and 1 notarized PCC by default.
3. The change of nationality/name after leaving China leads to unpredictable cost and result.

Your Full Name： Date：

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