Fillable Printable Police Certificate Application Form
Fillable Printable Police Certificate Application Form
Police Certificate Application Form
Version 20 May 2014
1
Note: Only use the latest version of the application form which can be accessed via the
ACPO website. www.acpo.police.uk Other forms provided may cause delays in
processing your application.
Payment:
Standard Service - £45.00 (10 working days, Not including da tes of receipt or dispa tch)
Premium Service - £80.00 (2 working days, Not inc luding dates of rece ipt or dispatch )
The Premium and Standard costs cover the processing of the certificate and standard
return postage, either 1
st
class Royal Mail or standard airmail for international post. The
applicant is advised to allow extra time if the application is made approaching or during
Public Holidays.
Acceptable payment methods are UK Sterling Cheque, Postal Order, Bankers Draft or
Bank Transfer. Payment must be made out to ‘Police and Crime Commissioner for
Hampshire’ or ‘PCC for Hampshire’. Do not send cash. If a receipt is required for the
payment this must be requested with the application.
If the applicant overpays by £10.00 or less the overpaid amount will be donated to
charity. If there is an overpayment of more than £10.00, the applicant will be contacted
to arrange a refund or to obtain their agreement to donate the overpaid amount to
charity.
If the applicant cancels the application after posting or ACRO cannot process the
application due to a failure by the applicant to respond to requests for information, an
administration fee of £10.00 will be deducted from any refund.
ACRO will NOT accept prepaid return envelopes or postal coupons provided by
customers, these will not be returned.
Optional services available on request:
Additional Certificate Copies - £6.00 each (If ordered at the time or within three
months of submission of the application)
Optional Postage Delivery - £9.00 per applicant per address, (UK next day or
secure international delivery)
Optional International Courier - £48.00 per return address
Delivery
ACRO Police Certificate Application
Guidance Notes
These notes apply to applicants wi shing to obtain a visa for Australia, Belgium,
Canada, Cayman Islands, New Zealand, South Africa or the United States of America
(Applications for other countries may be accepted subject to confirmation by the applicant of
acceptance by the relevant Embassy, High Commission or requiring organisation)
Version 20 May 2014
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Supporting Documentation:
To process your application, the following documentation is required:
1. Fully completed application form. Ensure all sections are completed in BLOCK
CAPITALS and in black ink, original signatures are required throughout. Scanned or
facsimile signatures will not be accepted.
2. TWO copies of different documents to prove your current address. Official
correspondence showing your name and address both dated within the last 6
months. These cannot be hand written and envelopes will not be accepted as
sufficient evidence. If these are not in English you will also need to provide a
translation which may be hand written.
3. Copy of your passport. Clearly showing passport photo, personal information
including expiry date, nationality, machine readable zone, extension pages if
applicable and signature.
4. ONE recent colour passport style photograph (Approximately 45mm x 35mm).
This should be appropriately endorsed on the back (See page 7).
5. Payment. UK Cheque, UK Postal Order, Bankers Draft, or Bank Transfer made
payable to ‘PCC for Hampshire’.
Do not send original documents as these will not be returned.
Additional Information:
ACRO will be unable to provide you with information contained on Police Systems by
email.
The validity of the Police Certificate is at the discretion of the relevant Embassy or High
Commission.
Please send the required items of documentation to the appropriate address:
If sending your application to ACRO by a courier service, your chosen courier company
must arrange for the application to be delivered to the above address. ACRO cannot
accept responsibility for lost items or the late or failed delivery of couriered items
showing any other address
Please ensure that you apply t he correct pos tage to your envelope otherwise your
application form may not be delivered to ACRO. Documents sent to the incorrect
address for the service required may delay your application.
All documents relating to your Police Certificate w ill be scanned and retained for a
period of at least 12 months, and the originals will be destroyed. Please note,
additional copies are only available up to 3 months from the submission of the
original application form.
If you are having difficulty in completing this application, please contact ACRO Customer
Services on 0845 60 13 999 during our office opening hours (08:30-23:00 UK) Monday to
Friday or via email to: custom[email protected]
If calling from outside the UK please dial +44 1962 871111 during the above UK times.
Address for Premium
Service:
ACRO (P)
PO Box 660
Fareham
Hampshire
PO14 9LN
(UK)
Address for Standard
Service:
ACRO
PO Box 481
Fareham
Hampshire
PO14 9FS
(UK)
Address for Courier
Delivery:
ACRO, c/o CitySprint
Unit 2, Solent Estate
Shamblehurst Lane
Hedge End
Southampton
SO30 2FX
Version 20 May 2014
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Police Certificate Application Form
This Application Form must be completed in English using
BLOCK CAPITALS and Black Ink
Service Requested: Standard Premium
Total Certificates Required:
Country relating to your visa or immigration application:
Australia
New Zealand
Canada
South Africa
United States of
America
Other
(Please specify)
Personal Information
Title: Mr Mrs Miss Ms Other (Please specify):
ALL Forename(s)/Given Name(s):
Surname/Family Name:
Have you ever used or been known by any other names?
Yes No
If yes, please provide a list of all other names below, including Maiden/Married
names. Failure to answer this question w ill delay your application. If you run out of
space please use the continuation page found at the end of this application form.
Other Forename(s) Other Surname(s)/Family Name(s)
Gender:
Male Female
Date of Birth (dd/mm/yyyy): - -
Tow n :
Place
of
Birth:
Country:
Nationality:
Passport
Number:
Contact Details
Home Telephone Number:
Mobile Telephone Number:
Work Telephone Number:
Email Address:
Print in CAPITALS
Version 20 May 2014
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WHEN ENTERING ADDRESSES IN THE FOLLOWING SECTIONS, PLEASE ENTER
THEM IN THE MAILING FORMAT RELEVANT TO YOUR COUNTRY.
Current Address:
This is the physical address at which
you reside and should be shown on
your proofs of address. If you cannot
provide proofs of address please
contact the enquiry number on page 2.
Postal Address(es) for the return
of your Police Certificate(s) if
different to your current address:
Please ensure you include c/o,
Department or Case Reference
Numbers if this is to be sent to an
Embassy/High Commission.
Have you lived at your current
address for 10 years or more?
If no, please provide your address
history from the last 10 years below:
Yes No
Previous Addresses and dates of occupancy
(Use the continuation page if necessary)
Previous Address 1:
Year: From To
Previous Address 2:
Year: From To
Previous Address 3:
Year: From To
If you have lived outside of the UK for the last 10 years please provide your last UK
address
Last UK Address:
Year: From To
Version 20 May 2014
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Service Required
Service Requested (1 certificate) Standard (£45) Premium (£80)
Number of Additional/Extra Certificates (£6 each)
If you are not requesting additional certificates leave blank.
Number: £
OPTIONAL Postage (If required please select only ONE)
IF 1
st
CLASS UK OR STANDARD AIRMAIL REQUIRED LEAVE BLANK
UK Next Day Delivery £9.00 per applicant £
Secure International Delivery £9.00 per applicant
THIS SERVICE IS NOT AVAILABLE TO PO BOXES
£
Courier – International Delivery ONLY £48.00 per return
address. Please provide a contact telephone number on page
3 so that delivery can be arranged. THIS SERVICE IS NOT
AVAILABLE TO PO BOXES
£
Payment Details
Total Payment Enclosed (Made payable to ‘Police and
Crime Commissioner for Hampshire’ or ‘PCC for
Hampshire’)
£
Payment
Method:
UK
Cheque
UK Postal
Order
Bankers
Draft
BX Ref (If Applicable):
Personal History
Please ensure that you complete all sections
Have you ever lived in Scotland?
If yes, please provide dates and addresses on the continuation
sheet, if different from page 4 above.
Yes No
Have you ever lived in Northern Ireland?
If yes, please provide dates and addresses on the continuation
sheet, if different from page 4 above. If you are a Northern Ireland
resident please provide your National Insurance and Driving
Licence (if applicable) numbers on the continuation sheet.
Yes No
Are you a serving, ex-serving, dependant or ex-
dependant, partner or ex-partner of a serving or ex-
serving member of the UK Armed Forces. Are you a
civilian that has been subject to UK Armed Forces Acts?
Yes No
Are you the subject of outstanding criminal proceedings?
If yes please provide full details on the continuation sheet.
Yes No
Have you ever been Arrested, Cautioned, Warned or
Reprimanded or been Convicted of a criminal offence in
England, Wales, Northern Ireland or Scotland? You must
declare all convictions including those you believe to be
spent under the Rehabilitation of Offenders Act 1974.
If yes, please provide details on the continuation sheet.
Yes No
Version 20 May 2014
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Applicant Declaration
1. I understand the questions asked in this application form and I declare that the
information I have supplied is accurate and I am the individual to whom it relates.
2. I declare I have listed all the names by which I have ever been known.
3. I authorise ACRO to make any enquiries it deems necessary in order to process this
application and verify the information contained herein.
4. I understand that the information I have provided may be used to update Police
Systems and that ACRO may share the information I have provided with other
agencies in the interests of law enforcement.
5. I understand that the Police Certificate will be prepared in accordance with the
appropriate rules governing Police Systems.
6. I am aware that if I make a statement or representation which I know to be false, I
may be subject to criminal proceedings.
7. I understand that I may be contacted by ACRO in relation to this application. If
necessary ACRO may leave telephone messages, or e-mail me.
8. I understand that this application will be delayed if:
I fail to complete the application form correctly, apply the correct postage, enclose
the required supporting documents or the correct payment, or send my applicatio n
to the incorrect address for the service level required.
I am subject to an impending/outstanding prosecution(s ) .
Searches are required of historical police databases.
Searches are required of other law enforcement databases.
There is an unforeseen event or occurrence such as postal service restrictions,
adverse weather conditions or computer system failure.
9. I understand it is my responsibility to ensure that an application for a country other
than Australia, Belgium, Canada, Cayman Islands, New Zealand, South Africa or
USA will be accepted by the relevant Embassy, High Commission or requiring
organisation. I also understand that ACRO will not be liable should a certificate not
be accepted by that body.
10. I understand that an overpayment of £10.00 or less will be donated to charity.
11. ACRO cannot be held responsible for items lost or delayed in the post by the postal
service or third party delivery companies (see FAQs)
Applicant Name (In BLOCK CAPITALS)
Applicant Signature
Date
- -
Version 20 May 2014
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Photograph Endorsement
In order to satisfy ACRO requirements, the back of your photograph needs to be signed
and dated by an individual employed as one of the following or similar profession:
Accountant Social Worker
Airline Pilot Solicitor
Ambulance Service Official / Paramedic Surveyor
A
rchitect Teacher
Bank / Building Society Official Trade Union Officer
Barrister Tutor
Care Worker (Registered) Valuer or Auctioneer
Company Chairman Veterinarian
Chemist Veterinary Nurse
Chiropodist
Civil Servant (Permanent)
Commissioner of Oaths
Councillor (Local or County)
Dentist
Director
Doctor
Engineer
Executive
Financial Adviser
Fire Service Official
Funeral Director
Insurance Broker
IT Specialist
Judge
Justice of the Peace
Lawyer
Lecturer
Legal Secretary
Magistrate
Manager
Medical Consultant/Specialist
Member of a Chartered Institute
Member of Parliament
Merchant Navy Officer
Minister of a Recognised Religion
Museum Curator
Notary Public
Nurse (SRN or other qualification)
Officer of the Armed Services (Active or Retired)
Optician
Personal Licence Holders (Liquor/Alcohol)
Personnel Officer
Pharmacist
Police Officer/Police Civilian Staff
Post Office Official
Prison Officer
Probation Officer
Salvation Army Officer
Version 20 May 2014
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To be completed by the individual endorsing the passport style photograph
This individual must be someone in one of the above occupations, other than your
partner or a family member, who has known you for a minimum of 2 years and is
eighteen years or over. Your individual must:
1) comple te, sign and date this page of the application form
2) write the surname/family name and date of birth of the applicant on the back of the
photograph
3) sign and date the back of the photograph
If you are living in a country in which you have not known a suitable individual for at
least two years, you will need to send this page and your photograph to someone who
has known you for two years to be signed. This individual can be of any
nationality/reside anywhere in the world and you do not need to be present when the
photograph is signed.
NOTE : The individual endorsing the photograph may be contacted to verify their
details.
Declaration and Information relating to the individual endorsing the photograph
1. I am not a family member or partner of the Applicant.
2. I am aged 18 years or over.
3. I have known the Applicant for a minimum of 2 years.
4. I have signed and dated the back of the photograph confirming that the image is a
true likeness of the Applicant.
5. I understand that this endorsement is for visa application purposes.
Name of Applicant
Name of Endorser
Signature of Endorser Date - -
Occupation (See list of acceptable
occupations on page 7, if in doubt please
contact ACRO Customer Services as shown on
page 2)
Name and address of Employer
(or Company if Self-employed)
Contact telephone number of Endorser
(Including international dialling code)
E-Mail address of Endorser
Print in CAPITALS
Version 20 May 2014
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Application Check List
(This page does not need to be returned with your completed
application and can be retained for your records)
Application Form (Fully completed and signed)
Two proofs of current address dated within the last 6 months
showing both your name and address (No documents will be
returned)
One recent colour passport style photograph (Appropriately endorsed
and dated)
Copy of Passport (Clearly showing photograph, passport information
with expiry date, nationality, signature, machine readable zone and
extension pages if applicable)
Northern Ireland residents ONLY: National Insurance and Driving
Licence (if applicable) numbers included on the continuation sheet
Correct payment including optional postage costs if applicable (Dated,
signed & payable to Police and Crime Commissioner for Hampshire
or PCC for Hampshire)
Documents are not to be stapled or pinned together
Please do not return guidance notes with your application form
If you are payin g for the Premium Service please send your
application to:
ACRO (P)
PO Box 660
Fareham
Hampshire
PO14 9LN
(UK)
Please ensure that you apply the correct postage to your envelope
otherwise your application form may not be delivered to ACRO
If you are payin g for the Standard Service please send your
application to:
ACRO
PO Box 481
Fareham
Hampshire
PO14 9FS
(UK)
Please ensure that you apply the correct postage to your envelope
otherwise your application form may not be delivered by ACRO
Version 20 May 2014
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Continuation Page
