Certificate of No Criminal Conviction Applicant Data Collection Form (Overseas)

(Please complete this form to assist the processing of your application for a Certificate of No Criminal Conviction) Date : _______/ _______ / _______ ..day../ .month ../ ..year (For official use only) Receipt date

Please give details of your application for visa/permanent residency status below:
COUNTRY FOR DATE OF VISA WHICH VISA APPLICATION APPLICATION HAS BEEN MADE
..__________/__________ (month / year)

ARE YOU THE PRINCIPAL IF YES, HOW MANY DEPENDENT VISA APPLICANT MINORS ARE COVERED IN YOUR APPLICATION FOR WHOM CNCCs ARE 1. Yes 2. No NOT REQUIRED?

4 6 10 11 12 13 14

PURPOSE OF APPLICATION 1 To Obtain Permanent Residency Status 2 To Obtain/Renew Student/Exchange Visitor Visas 3 Other Purposes (including Business & Tourist)
TYPE OF TRAVELLING DOCUMENT HELD 1 2 3 4 Hong Kong Passport Hong Kong Certificate of Identity Hong Kong Document of Identity Other Hong Kong Travelling Document, specify:

(To be completed by applicants for Permanent Residency Status only.) IMMIGRATION CLASS 1 Family/Marriage 2 Independent/Employment 3 Investment/Business 4 Retirement 5 Others, specify

5 Other National Passport, specify issuing country: 6 Other type of Travelling Document, specify issuing country

HOW MANY CNCC APPLICATIONS FOR PERMANENT RESIDENCY STATUS HAVE YOU MADE IN THE LAST TWELVE MONTHS?

15

17

AGE (in complete year)

SEX 1 Male 2 Female

Marital Status 1 Never married 2 Married

3 Divorced/Legally separated 4 Widowed WHETHER GRADUATED

19 20 21 22 23 25 26 29

EDUCATIONAL ATTAINMENT 1 Primary & below (Primary VI & below) 2 High School (Form I-III) or Equivalent 3 High School (Form IV-V) or Equivalent 4 High School (Form VI) or Equivalent CURRENT ACTIVITY STATUS 1 Working 2 Studying 3 Not Working

5 High School (Form VII) or Equivalent 6 Post-Secondary (Non-degree Course) 7 First Degree 8 Postgraduate

1 Graduated 2 Not Graduated LENGTH OF STAY IN HONG KONG (in complete year)

IF 1 IS TICKED, PLEASE STATE: JOB TITLE (e.g. teacher, accounting clerk, restaurant manager, etc. Avoid using general terms such as government servant, factory workers, etc) JOB DUTIES (e.g. teaching at high school, accounting work, restaurant management, quality check in garment production, etc) JOB ENTRY QUALIFICATIONS (e.g. a University Degree, an associateship in accounting, a business management diploma, a certificate in quality control, etc)

(To be completed by persons who held Hong Kong travel documents ONLY when departed from Hong Kong) WHEN DID YOU DEPART FROM HONG KONG EDUCATIONAL ATTAINMENT WHEN YOU LEFT HONG KONG 1 Primary & below (Primary VI & below) (month/year) 2 Secondary (Form I-III) or Equivalent AT THAT TIME, DID YOU LEAVE HONG KONG ON AN 3 Secondary (Form IV-V); (including Craft/Apprenticeship courses IMMIGRANT VISA? at Technical Institutes or Equivalent.) 1 Yes 4 Matriculation (Form VI) or Equivalent 2 No 5 Matriculation (Form VII) or Equivalent IF NO, WHAT KIND OF VISA? 6 Post-Secondary (non-degree Courses, including Polytechnic and 1 Student & Exchange Visitor Technician level courses at Technical Institutes) 2 Others, please specify 7 First Degree SINCE LEAVING HONG KONG, HAVE YOU ACQUIRED PERMANENT RESIDENCY STATUS OR CITIZENSHIP OF ANY 8 Postgraduate OTHER PLACE? 1 Yes 2 No IF YES, PLEASE GIVE DETAILS (DATE, COUNTRY ETC.) DCS 415 (Rev. 1/99 PLEASE STATE WHETHER GRADUATED 1 Graduated 2 Not Graduated

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