Application Proforma for Police Clearance Certificate for Foreigners

Name __________________________________
Postal Address ___________________________

Photo ___________________________
___________________________
Phone/Mobile No. ________________________
Date ___________________________________

Subject: Police Clearance Certificate

Sir/Madam,
I, Mr./Mrs./Ms./Mast. ______________________________________ (name) Citizen of
____________________ (nation), went to India on ________________ (date of first entry) current
Passport No. ___________________, request you to please issue me Police Clearance Certificate
for __________________________________________________________________
_________________ (reason) for the period from _________________ to ________________.
(DD/MM/YYYY) (DD/MM/YYYY)

The detailed information about my stay in India is as follows:

Period from FRO/FRRO
Address
(DD/MM/YYYY) to (DD/MM/YYYY) (City/District)

( )
Signature and Name of Applicant
Accompaniments:
1) Copy of Passports
2) Copy of visa/PIO/OCI cards
3) Copy of Residential Permit
4) Copy of Registration Certificate
5) Residence proof
 Performa to be attached with the application for
PCC by Foreign National for stay in India

Name of applicant
Address:
Residential
Office / Business / Educational
Contact No. / Care off No.
Nationality

Passport No.

Type of Visa & No.

FRRO/FRO Registration

Date of First Entry in India

Permitted to Stay in India till date

Purpose of Visiting India

Residential Address
where applicant has stayed more (i)
than 6 months at a time. Each stay ( ii )
to be specified
Purpose for which PCC required

Period of PCC required

Whether Overstayed while in Inida?

Whether Indian Visa denied ever

Any other information applicant would
like to furnish

Signature of applicant
 Detail For PCC

Surname: First Name

Father Name:
Nationality: Mobile No.:
Address:

Departure
Arrival date Collage &
Passport Details Visa Details date with R. P. No.
with page no. Course
page no.
Passport No. Visa No.
Date of Issue Date of Issue
Valid till Valid till

Passport No. Visa No.

Date of Issue Date of Issue
Valid till Valid till

Passport No. Visa No.

Date of Issue Date of Issue
Valid till Valid till

Passport No. Visa No.

Date of Issue Date of Issue
Valid till Valid till

Passport No. Visa No.

Date of Issue Date of Issue
Valid till Valid till

Passport No. Visa No.

Date of Issue Date of Issue
Valid till Valid till

List of Documents for PCC

1) All Passport copies 2) All visa copies 3) All R. P. copies
4) All degree certificate 5) All arrival & departure in India Stamp pages mentioned above

Signature of applicant