To Senior Superintendent of Police Kapurthala. Subject:- Application for Police Clearance Certificate. (For persons residing in India) Sir, It is respectfully submitted that :- 1. I _____________________________ S/o,D/o,W/o __________________________ am permanent resident of village _____________________________________ PS_______________________________ District Kapurthala 2. I do not take part in any anti National/social activities 3. There is no Civil/Criminal case pending against me in any court of law else were in India 4. I command a good reputation and respect in general public. 5. I have never changed my name. 6. My date of birth is ________________ (in words) ____________________________ 7. My Passport No. is ______________________ issued by ____________________ valid up to________________________. 8. I am in need of police clearance certificate as the same is required to be produced before (name of embassy) _________________ for the purpose of ___________________________ It is therefore requested that I may please be issued Police Clearance Certificate. Documents Attached (Tick whichever is applicable) 1. 4 Passport size Photographs. 2. Photocopy of Ration Card/ Driving license/Voter I-card/Pan Card or any other residence certificate. 3. Photocopy of Passport. 4. Photocopy of School Certificate/ Date of Birth Certificate. Yours Faithfully, Signature ( ) Name Address Phone Number Date: Photo