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    Police Clearance Certificate Form

    Uploaded by

    Aman Rajput

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Police Clearance Certificate Form

    Uploaded by

    Aman Rajput
    11 views1 page

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
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    11 views1 page

    Police Clearance Certificate Form

    Uploaded by

    Aman Rajput

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    7/25/23, 6:43 PM Police Clearance Certificate Form

    Police Clearance Certificate Form

    Government of INDIA, Ministry of External Affairs

    Application Reference Number 23-0014025290


    Passport Details
    Passport Number R2557398
    Passport Issue Date 04/07/2017
    Passport Expiry Date 03/07/2027
    Place of Issue JALANDHAR
    Region/Country for which PCC is required POLAND
    Purpose for which PCC is required EMPLOYMENT/EMPLOYMENT VISA/WORK PERMIT
    Applicant Details
    Applicants Name HARPREET SINGH
    Date of Birth (DD/MM/YYYY) 27/02/1989
    Place of Birth (Village/Town/City) MEHANDIPUR HOSHIARPUR
    Gender MALE
    Marital Status SINGLE
    Citizenship of India by BIRTH
    Employment Type PRIVATE
    Educational Qualification 10TH PASS AND ABOVE
    Aadhaar Number 228871386884
    Family Details
    Fathers Name SHAM SINGH
    Mothers name BALWINDER KAUR
    Present Residential Address Details
    VILL DHUPSARI PO KIRI KHURD PATHANKOT TARAGARH
    Address
    PUNJAB
    Pin 143534
    Mobile/Tel No. 8146453186
    E-mail Id [email protected]
    Permanent Residential Address Details
    VILL DHUPSARI PO KIRI KHURD PATHANKOT TARAGARH
    Address
    PUNJAB
    Pin 143534
    Mobile/Tel No. 8146453186
    Other Details
    Self Declaration

    I owe allegiance to the sovereignty, unity & integrity of India, and have not voluntarily acquired citizenship or travel document of any
    other country. I have not lost, surrendered or been deprived of the citizenship of India. I have not contravened any of the conditions
    relating to the possession and use of an Indian passport.
    I affirm that the information and particulars given by me in this form are true and correct. I further state that I am not suppressing any
    material information in this regard. I further affirm that the enclosures and documentary proof submitted in support of my application
    for an Indian passport are authentic and solely pertain to me and I am fully responsible for the accuracy of the same. I am liable to be
    penalized or prosecuted if found otherwise. I am aware that under the Passports Act, 1967 it is a criminal offence to furnish any false
    information or to suppress any material information with a view to obtaining passport or travel document.
    I have read and understood the contents of the above and by submitting this form certify that all the information submitted by me in
    the form is bonafide.

    Place SOHAURA KALAN


    Date 25/07/2023

    https://portal1.passportindia.gov.in/AppOnlineProject/secure/pccApplicantSelfDeclarationAction 1/1

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