POLICE CLEARANCE CERTIFICATE APPLICATION FORM

To
The Superintendent of Police,
District Police Office,
Jaipur Rajasthan
_________________.
Applicant must paste
one photograph 35mm
Subject: Application for issuance of PCC x 35mm here with half
the signature on the
Sir, photograph and half on
the application

may be issued to me for a wrong upi transfer purpose. My Account

It is requested that a Police Clearance Certificate
personal particulars are as follows:

Full Name (Expanded Initials) _Mahesh Kumar _______________________________________

Sex _______________________________________________________________
Male

Girraj Meena
Previous Name (in case the name has been changed)________________________________

Date of Birth _______________________________________________________

Occupation ________________________________________________________
Self - Employee

Father (Full Name) _____Gordhan Meena______________________________________________

Mother (Full Name) __________________________________________________

Kamala

Spouse (Full Name) __________________________________________________

Hardi lahariyo ki dhani khuthada khurd bassi jaipur 303012

Permanent Address __________________________________________________
___________________________________________________________________
Rajasthan India,

Present Address ____________________________________________________

Hardi lahariyo ki dhani khuthada khurd bassi jaipur 303012
___________________________________________________________________
Rajasthan India,

Residing at current address since ______________________________________

19-21 Years

AADHAR No.________________ Date of birth __________ Sex __________

Aadhar issued by: Regional UIDAI Officer ____Sub Distic Bassi_____________________

It is further stated that I am a citizen of India and have not been involved
in any criminal case in India and that there is no criminal case pending against
me in the Court of Law.

____________________
(Signature of Applicant)
_________________
04-04-2024
(Date)