7/31/2018 Police Clearance Certificate Form

Police Clearance Certificate Form

Government of INDIA, Ministry of External Affairs

Application Reference Number 18-0012003300

Passport Details
Passport Number Z3664456
Passport Issue Date 23/07/2016
Passport Expiry Date 22/06/2026
Place of Issue NEW DELHI
Country for which PCC is required CANADA
Applicant Details
Applicants Name RAMNEEK SINGH
Date of Birth (DD/MM/YYYY) 22/10/1984
Place of Birth (Village/Town/City) NEW DELHI
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
Employment Type PRIVATE
Educational Qualification GRADUATE AND ABOVE
Aadhaar Number 629687632963
PAN BWPPS5321E
Family Details
Fathers Name TIRLOK SINGH
Mothers name JASBIR KAUR
Spouses Name PRATIKSHA VARMA
Present Residential Address Details
34 ANAND VIHAR PITAMPURA NEW DELHI NORTH WEST
Address
DELHI SUBHASH PLACE DELHI
Pin 110034
Mobile/Tel No. 8860086480
E-mail Id RAMNEEK2210@GMAIL.COM
Permanent Residential Address Details
34 ANAND VIHAR PITAMPURA NEW DELHI NORTH WEST
Address
DELHI SUBHASH PLACE DELHI
Pin 110034
Mobile/Tel No. 8860086480
Other Details
Have you ever been charged with criminal proceedings or is any
NO
arrest warrant/summon pending before a court in India?
Self Declaration

I owe allegiance to the sovereignty, unity and integrity of India, and have not voluntarily acquired citizenship or travel document of any
other country. I have not lost, surrendered or been deprived of the citizenship of India and I affirm that the information given by me in
this form and the enclosures is true and I am solely responsible for its accuracy, and I am liable to be penalized or prosecuted if found
otherwise. I am aware that under the Passports Act, 1967 it is a criminal offence to furnish any false information or to suppress any
material information with a view to obtaining passport or travel document.

Place NEW DELHI

Date 31/07/2018

https://portal1.passportindia.gov.in/AppOnlineProject/secure/pccApplicantSelfDeclarationAction 1/1