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Request Letter for Police Clearance Certificate by Passport Holder

A Police Clearance Certificate (PCC) is generally issued to Indian Passport holders in cases where they have applied for Residential Status or going for Employment or Long term visa or for immigration to another country.

application for police clearance certificate by an indian passport holderPolice Clearance Certificates are not issued to persons going abroad on Tourist Visa. It is not needed in that case.

If you need a PCC, then you have to apply to the Police Station in your locality assigned for passport purposes. Please enquire with the Passport office to find out which Police station is assigned for the resident address of yours.

Different police stations of various localities may have separate formats of application form for applying for PCC. Please check with them to find out. In case they suggest you to write an application letter on your own with all the necessary details and attach the necessary documents then you can do so.

Government has also started an initiative to make this process fully digital so that the passport holders can apply online for issuance of PCC.

The following format of application letter could be used in case there is not already a prescribed form.


To                                                                                       ______________
The Superintendent of Police                                               Affix passport
________ Police Station                                                     size Photograph
____________ (Address)                                                  ______________

Sub.: Request for issue of Police Clearance Certificate.

Dear Sir,

I am hereby applying for the issuance of a Police Clearance Certificate to me for visa/immigration purposes. The personal details of mine are mentioned hereunder for your kind reference.

(i) Name: ______________. (ii) Previous Name (in case name changed): ______________.
(iii) Gender: ______________. (iv) Date of birth: _________. (v) Place of birth: ______________.
(vi) Occupation: ______________. (vii) Nationality: ______________.
(viii) Father's Name: ______________. (ix) Mother's Name: ______________.
(x) Spouse's Name: ______________. (xi) Permanent Address: ______________.
(xii) Present Address: ______________. (xiii) Residing at current address since: ______________.
xiv) Passport details:
Passport No. _________. Date of issue: _________. Place of issue: _________. Valid till: _________.
xv) Country for which Visa/Immigration has been applied: ______________.
xvi) My contact no.:
Res. Tel. No. _________. Off. Tel. No. _________. Mob. _________. Email Id: _________.

xvii) Name, address and signature of two references of the people in my locality, to whom I am known.
Reference #1 - Name: ____________. Address: ______________. Signature: ________.
Reference #2 - Name: ____________. Address: ______________. Signature: ________.

I certify that the above-mentioned information is correct and complete to the best of my knowledge.

I do solemnly declare and affirm that I have never been convicted by any court in India or abroad, and that I have never been involved in any criminal case in India, and that there is no criminal case pending against me in a Court of Law.

I am enclosing herewith all other necessary documents. Kind request to your good office to issue my Police Clearance Certificate as soon as possible.

Thanking you,
Yours faithfully,

(Name of the Applicant)
Mob. __________

Date: __________
Place: __________

1) Photocopy of Passport.
2) Photocopy of Matriculation certificate.
3) Proofs of permanent and present addresses (Aadhar card/ Electricity/ telephone bill/ ration card, etc.).
4) Copy of valid Visa.
5) Employment contract copy.
6) Other documents: ______________________________.

police clearance certificate for passport application


  1. Rajib Agarwal22 August, 2018

    Thanks for the application format for PCC.

  2. Sumit Rajlani08 October, 2018

    Thank you. I needed the format urgently.


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