Fillable Printable Application for Police Verification Form - Karnataka
Fillable Printable Application for Police Verification Form - Karnataka
Application for Police Verification Form - Karnataka
Application for Police Verification
To
The Commissioner of Police / Superintendent of Police / SHO
_________________________ City / District / Police Station.
Karnataka.
Sir,
Sub: - Request to issue Police - Verification / Clearance Certificate
for the Purpose of.
Sl.
No.
Name of the Verification Certificate
Amount in Rupees
Select
appropriate
Certificate
required
(1)
(2)
(3)
(4)
1.
Police Verification Certificate (PVC/PCC) for
Job Purpose to MNCs/Private Sector/ Corporate & other
companies ANTECEDENTS VERIFICATION ONLY (as
per police station records)
300/-
2.
Police Verification Certificate (PVC/PCC) for
Job Purpose to MNCs/Private Sector/ Corporate/ & other
companies ANTECEDENTS VERIFICATION along with
ADDRESS VERIFICATION amount to be paid by the
company.
1,000/-
3.
Police Verification Certificate for job aspirants(General)
ANTECEDENTS along with ADDRESS VERIFICATION
250/-
4.
Police Verification Certificate for Domestic servants /
House Keeping ANTECEDENTS VERIFICATION ONLY.
250/-
5.
Police Verification Certificate for Domestic servants /
House Keeping ANTECEDENTS VERIFICATION along
with ADDRESS VERIFICATION.
500/-
6.
Police Verification Certificate of Institutions /Companies
ANTECEDENTS VERIFICATION along with ADDRESS
VERIFICATION.
1,000/-
7.
Police Verification Certificate for Marriage Alliances
ANTECEDENTS VERIFICATION.
300/-
8
Police Verification Certificate for Training/Apprenticeship
at Public sector undertakings or for Trainees / Workers
working on daily wages at Government Institutions.
ANTECEDENTS VERIFICATION.
50/-
9.
Police Verification Certificate for NCC / NSS Students
attending training camps ANTECEDENTS
VERIFICATION.
50/-
10.
Police Verification Certificate for Cooli / Loader / Class
IV security staff / supervisor at Airport. (Individual
applicants only) ANTECEDENTS VERIFICATION
100/-
11.
Police Verification Certificate for Central / State
Government Employees request directly by employee.
ANTECEDENTS VERIFICATION.
250/-
12.
Police Clearance Certificate (PCC) for going abroad
(Visa for studies)
200/-
13.
Verification and comparison of Finger Print
500/-
..2..
Passport Size
Photo
1.
Verification of service local Jurisdiction.
2.
Verification of service outside Jurisdiction.
3.
Any other purpose
The verification done through Department as per Government Order’s : -
(1)
(2)
(3)
(4)
1.
PIO / OCI Cards
As per Govt Order
2.
Pakistan Visa
As per Govt Order
3.
Verification of Citizenships
As per Govt Order
4.
Government Employees Job Verification done through
the department.
As per Govt Order
Note: - Please tick the appropriate one.
With regard to the above following are the personal details for whom the PVC / PCC is
required.
1. Name
2. Father/
Husband
name
3. Nationality
4. Date of Birth & Age Age Years
5. Present
Address
a. Period of stay
6. Permanent
Address
7. Address needs
to be verified
with period of
stay.
Period of stay
(Enclose additional sheet for more than one address)
d
d
m
m
y
y
y
y
..3..
8. Name of the Jurisdiction Police
Station.
9. Contact telephone Number. (a) Land line (b) Mobile.
10. Details of fee remitted:
(a) Transaction Number of
Bangalore One /Karnataka One:
(Please enter the 12 digit transaction number in the boxes above. First 3 characters are
Alphabetical and rest 9 characters are Numerical.).Original Receipt has to be enclosed
(b) Treasury / Bank:
(Pl enter the challan Number)
Original Challan has to be enclosed
11. Do you possess a passport Yes
If yes furnish particulars as below
a. Passport Number b. Date of issue
c. Validity d. Place of issue
The information furnished in this application is true to the best of my / our knowledge & belief.
No information has been suppressed.
Please verify the ANTECEDENTS and / or the STAY DETAILS of the above named person at the
given address for the given period of stay and issue the PVC/ PCC.
Thanking you
Yours faithfully
Date :
Place:
Signature of the Applicant /
the I/c of the Company / firm.
From Address:
___________________________
___________________________
___________________________
Instructions.
1. Applicant should furnish one of the approved documents by the State Government for the
purpose of address proof.(Passport, Pan card, Ration Card, Voter ID, BSNL Telephone
Bill, Gas Bill, Water Bill, Electricity Bill, Driving License)
2. Enclose two additional passport size photos along with the application.
3. Furnish the proof of date of birth.
4. The PVC / PCC issued shall not be used for any other purpose other than the purpose
specified in the application.
No
