Police Clearance Certificate Application Form Gurgaon PDF

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Police Clearance Certificate Application Form Gurgaon

For Police Clearance Certificate (PCC)  the applicant is first required to fill the prescribed Application form and A Government fee of Rs. 300/- is to be deposited for Police Clearance Certificate( PCC). Along with the challan form duly marked may be deposited in the nearby branch of State Bank of Patiala at District Court Complex, Gurugram. The Application form and Challan form, complete in all respect, should be deposited in the Security Branch of Gurugram Police.

Gurugram Police Clearance Certificate Form (Required Details)

  • Name of the applicant
  • Address to be verified
  • Police Station
  • Permanent address
  • Passport No
  • Fathers/ Husband name
  • Pass Port No.
  • Date of issue Passport and Expiry date
  • Place of issue Pass Port
  • Purpose of PCC and country name
  • Mobile Number
  • E-Mail ID
  • Signature of applicant
  • And any Other details

Documents Required for Police Clearance Certificate Form

Photocopy of the following documents should be self-attested by the applicant before applying for PCC for foreign countries only.

  • A valid Pass Port.
  • Letter/ Instruction of the Embassy demanding the PCC.
  • PassPort Size two Photographs.
  •  Residence proof (In addition to PassPort).
(POI) Proof of identity(POR) Proof of residence
 Aadhar Card Electricity/Water bill provided by DHBVN/MCG/GMDA OR Electricity/Water/Society Maintenance bill provided by the Developer.
 Voter Card Copy of Notarized Rent agreement of 11 months Rregistered agreement more than 12 months.
 Passport Telephone Bill ( Landline or Post Paid Mobile Bill )
 Driving License Proof of Gas Connection.
 Haryana Residence certificate Income Tax Assessment order.
 Any Govt. ID Card Certificate from Employer of reputed Companies on letterhead.
 Photograph Passbook of Running bank account (Scheduled Public Sector Banks Scheduled Private Sector Banks and Regional Rural Banks Only) Verification Request letter from employee to DCP/CP GGM (Compulsory for Employee verification).
 Parivar Pehchan Patra(PPP)

You can download the Gurgaon Police Clearance Certificate Application Form in PDF format from the official website of the Haryana Police at the link is given below.

Challan Form

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