Application for Police Verification

To Passport Size
The Commissioner of Police / Superintendent of Police / SHO Photo
_________________________ City / District / Police Station.
Karnataka.

Sir,
Sub: - Request to issue Police - Verification / Clearance Certificate
for the Purpose of.

Select
Sl. Amount in Rupees appropriate
Name of the Verification Certificate
No. Certificate
required
(1) (2) (3) (4)
1. Police Verification Certificate (PVC/PCC) for
Job Purpose to MNCs/Private Sector/ Corporate & other
300/-
companies ANTECEDENTS VERIFICATION ONLY (as
per police station records)
2. Police Verification Certificate (PVC/PCC) for
Job Purpose to MNCs/Private Sector/ Corporate/ & other
companies ANTECEDENTS VERIFICATION along with 1,000/-
ADDRESS VERIFICATION amount to be paid by the
company.
3. Police Verification Certificate for job aspirants(General)
250/-
ANTECEDENTS along with ADDRESS VERIFICATION
4. Police Verification Certificate for Domestic servants /
250/-
House Keeping ANTECEDENTS VERIFICATION ONLY.
5. Police Verification Certificate for Domestic servants /
House Keeping ANTECEDENTS VERIFICATION along 500/-
with ADDRESS VERIFICATION.
6. Police Verification Certificate of Institutions /Companies
ANTECEDENTS VERIFICATION along with ADDRESS 1,000/-
VERIFICATION.
7. Police Verification Certificate for Marriage Alliances
300/-
ANTECEDENTS VERIFICATION.
8 Police Verification Certificate for Training/Apprenticeship
at Public sector undertakings or for Trainees / Workers
50/-
working on daily wages at Government Institutions.
ANTECEDENTS VERIFICATION.
9. Police Verification Certificate for NCC / NSS Students
attending training camps ANTECEDENTS 50/-
VERIFICATION.
10. Police Verification Certificate for Cooli / Loader / Class
IV security staff / supervisor at Airport. (Individual 100/-
applicants only) ANTECEDENTS VERIFICATION
11. Police Verification Certificate for Central / State
Government Employees request directly by employee. 250/-
ANTECEDENTS VERIFICATION.
12. Police Clearance Certificate (PCC) for going abroad
200/-
(Visa for studies)
13. Verification and comparison of Finger Print 500/-

..2..
1. Verification of service local Jurisdiction.
2. Verification of service outside Jurisdiction.
3. Any other purpose
The verification done through Department as per Government Orders : -
(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
As per Govt Order
the department.
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

d d m m y y y y
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)

 ..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 No

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.