PERSONAL DATA

CNCC NO.
(For Official Use Only )

APPLICATION FOR CERTIFICATE OF NO CRIMINAL CONVICTION

I, the undersigned, hereby make application to the Commissioner, Hong Kong Police for a Certificate of No Criminal Conviction: : -

APPLICANT: Mr./Mrs./Miss/Mdm.
: ( / /)

H.K.ID Card / Travel Document No.:

/ :

ADDRESS : :

TEL: : Note: Applicants for Certificates of No Criminal Conviction should familiarize themselves with the Notes to Applicants which contain the terms and conditions for the issue of Certificates of No Criminal Conviction.
:

Date: : (For Official Use Only ) Fee received.

Applicant Signature:
:

Left Thumb

Interviewed by

Receipt No.:

Pol. 172A (Rev 1/10)

Date:

Shroff

Pol. 172A (Rev 1/10)