Indian Police Clearance Certificate Form

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Applicant Given name*
Surname
Birth Details*
District State Pincode of Birth Place
Purpose of PCC*
Marital Status*
Employment type*
Educational Qualification*
Length of residence abroad/out of India*
Adhaar Number (If any)
Father Name as per passport
Given Name*
Surname
Mother Name as per passport
Given name*
Surname
Spouse Name as per passport
Given name
Surname
Applicant's Email Id*
Applicant's Mobile Number*
Police Station (As per Indian passport address)*
Police Station
Local Address (Australia)*
Street Address City State / Province / Region ZIP / Postal Code Country
References in India
e.g. Neighbors/Friends/Relatives living in the Same Area. House Number should be DIFFERENT.
1. Reference person Details (in India)
e.g. Neighbors/Friends/Relatives living in the Same Area. House Number should be DIFFERENT.
Contact name*
Address*
Street Address Address Line 2 District State / Province / Region ZIP / Postal Code Country
Mobile Number*
2. Reference person Details (in India)
e.g. Neighbors/Friends/Relatives living in the Same Area. House Number should be DIFFERENT.
Contact Name*
Address*
Street Address Address Line 2 District State / Province / Region ZIP / Postal Code Country
Mobile Number*
Applicant's Indian Contact Number*

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Father Name as per passport