Police Clearance Certificate Application Form printable pdf download

Police Clearance Certificate Application Form

HIGH COMMISSION OF INDIA, LILONGWE

Paste your

Phone No.01755337, Fax No.01755346

unsigned recently

e-mail :

cons.malawi@mea.gov.in

taken colour

Website:

photograph

POLICE CLEARANCE CERTIFICATE APPLICATION FORM

(showing both the

ears)

Signature (as given in passport) OR Thumb

impression

Please fill this form in CAPITAL LETTERS. Furnishing of incorrect information/suppression of information would lead to

rejection of the application and would attract penal provisions as prescribed under the Passports Act, 1967. Please furnish your

original documents at the time of submission of the form. Please leave a blank column in between two words

Passport Number

Date of Issue

Place of Issue

Date of Expiry

Country for which PCC is required

1. Applicant's given name (given name means First Name followed by Middle Name (if any) (initials not allowed)

Surname

2.1 Father's given name (given name means First Name followed by Middle Name (if any) (initials not allowed)

Surname

2.2Mother's given name (given name means First Name followed by Middle Name (if any) (initials not allowed)

Surname

2.3 Spouse's given name (given name means First Name followed by Middle Name (if any) (initials not allowed)

Surname

3. Present Residential Address

Mobile Number

Telephone Number

E-Mail ID

4. Permanent Residential Address

Police Station

Police Clearance Certificate Application Form