The __________ (Superintendent of Police/ Commissioner),
___________ (Address),
___________ (City)

Date:__/__/____ (Date)

Subject: Application for issuance of Police Clearance Certificate (PCC)

Respected Sir/ Madam,

I __________ (Name) S/o, ____________, a resident of ____________ (Residential Address) writing this letter to you in order to request you to kindly issue a Police Clearance Certificate in my name. I need this for _______________ (Job/ Visa/ Immigration/ Marriage/ Study Purpose – Mention your reason). The following are my details mentioned below:

Name: _________
Date of Birth: _________
Occupation: _________
Sex: _________
Permanent Address: _________
Passport Number: _________

I also state that I am a citizen of __________ (Name of the country) and I have never been involved in any criminal cases. I am hereby enclosing _________________ (PCC application form/ KYC document/ Passport/Any Other Document – if Applicable).

Thanking you,

__________ (Signature)
__________ (Name),
__________ (Address),
__________ (Contact Number)

Note: Some countries and states won’t accept the manual application. You may be asked to submit a Police Clearance Certificate online using the Official website. For more details contact the concerned authority for PCC issuance.

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