"Application Form for Police Clearance Certificate - Embassy of India" - Stockholm, Sweden

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Embassy of India
Stockholm
Application Form for Police Clearance Certificate
(Please Use Typewriting or Black Ink Pen with Clear Handwriting and Block Letters)
Write names in extended forms and not initials
Name of Applicant :
_____________________________________________
Previous or Maiden Name :
_____________________________________________
Father/Husband’s Name :
_____________________________________________
Date of Birth :
____________________ Place of Birth : ______________________
Present Nationality :
_____________________________________________
Date of acquisition of foreign nationality, if applicable : ________________________
Passport No. :
____________________ Place of Issue : ______________________
Date of Issue :
____________________ Passport Validity : ___________________
Permanent Address :
__________________________________________________
Present Address :
__________________________________________________
Contact Particulars :
Office/Home :
___________________ Mobile :
________________________
Fax : _____________________________ E-mail :
________________________
Purpose for which PCC is required : ________________________________________
Declaration :
I ___________________________________, presently __________________ national
and holder of Passport No. ____________________ dated ____________________
hereby declare that there is no criminal or civil case pending against me in any Court of
India.
…………………………………………….
……………………………….
(Date & Place)
(Signature)
Embassy of India
Stockholm
Application Form for Police Clearance Certificate
(Please Use Typewriting or Black Ink Pen with Clear Handwriting and Block Letters)
Write names in extended forms and not initials
Name of Applicant :
_____________________________________________
Previous or Maiden Name :
_____________________________________________
Father/Husband’s Name :
_____________________________________________
Date of Birth :
____________________ Place of Birth : ______________________
Present Nationality :
_____________________________________________
Date of acquisition of foreign nationality, if applicable : ________________________
Passport No. :
____________________ Place of Issue : ______________________
Date of Issue :
____________________ Passport Validity : ___________________
Permanent Address :
__________________________________________________
Present Address :
__________________________________________________
Contact Particulars :
Office/Home :
___________________ Mobile :
________________________
Fax : _____________________________ E-mail :
________________________
Purpose for which PCC is required : ________________________________________
Declaration :
I ___________________________________, presently __________________ national
and holder of Passport No. ____________________ dated ____________________
hereby declare that there is no criminal or civil case pending against me in any Court of
India.
…………………………………………….
……………………………….
(Date & Place)
(Signature)