Facilitation Charges = ` 100/-
PUNJAB TRANSPARENCY AND ACCOUNTABILITY ACT 2018 Stipulated Time = 10 Days
Details of 'Saanjh' Kendra :- Name of Centre
District
Service asked for :- POLICE CLEARANCE CERTIFICATE(FOR VISA)
APPLICANT DETAILS :- Date D D M M Y Y Y Y
Name S/o D/o W/o Relation Name
Alias(s)
Gender Male Female Transgender
Passport
size
Nationality
Photograph Signature
D.O.B
Place of Birth.
Mobile No. E-mail ID.
Passport No. Place of issue.
Date of Issue Valid Upto.
Home/Flat/Plot/Property No. St. No./Name
Present
Address Sector/Village/Colony/Society Pincode
Police Station District State
Home/Flat/Plot/Property No. St. No./Name
Permanent
Sector/Village/Colony/Society Pincode
Address
Police Station District State
Have you ever changed your name Yes No Detail of Name (if Yes)
Whether any Criminal case registered against applicant Yes No
If Yes, details of criminal case registered in India and abroad
Any other Legal/Criminal proceeding initiated against applicant
Purpose of applying service Name of Embassy/Country
(Type of VISA)
Self Attested copy of passport
Photo ID type Self Attested copy of address proof [ Aadhar Card/DL/Voter Card/Any other ________________________ ]
Govt./Bank Issued- Self Attested copy of Birth Proof [Birth Certificate / 10th Certificate/ Any other _______________________]
Passport size photographs 2 Document No.
If you change your name [attested copy of gazette].
NOC is required in case of Govt. Employee.
SELF DECLARATION :-
(I) I Declare that all the above information given by me, is best of my knowledge & belief.
(II) In future if any information found false then any legal action can be taken against me.
(III) I do not take part in any Anti-national/Anti social Activities.
HELP US IN FIGHT AGAINST CORRUPTION
Call Vigilance Bureau Toll Free No. 1800-1800-1000 or visit www.vigilancebureau.punjab.gov.in
