Application for Grant of
Police Character Certificate from Pakistan
(to be filled in Capital Letters)
Part-A
Passport Size
Photographs of the
Applicant
1
Name of the Applicant:
First:
Middle:
Last:
2
Father’s/Husband’s Name:
First:
Middle:
Last:
3
Permanent Address
(in Pakistan):
4
Temporary Address
(abroad) including Tel and e-mail:
5
Address and Duration of Stay in
Pakistan for which clearance is
required:
6
Profession:
7
Pakistani CNIC / NICOP No.
(for Pakistanis only)
8
Passport No.
Nationality:
9
Purpose of obtaining Character
Certificate and name of the country
Date: _______________
Signature:
________________________
Place:
________________________
Part-B
Statutory Declaration
I _____________________________________ s/o, d/o, w/o __________________________________ do hereby
solemnly affirm and declare the following as per the requirements of the Statutory Declaration Act of 1959:
i. That I am a Pakistani National;
ii. That the information contained in Part-A of the form is true and correct to the best of my knowledge and
belief.
iii. That I hold a Pakistani Passport as per details given above (Part-A of the Application);
iv. That I hold a CNIC / NICOP which is genuine and valid (particulars mentioned in Part-A of the
Application);
I understand that if I intentionally make a false statement in a statutory declaration I will be guilty of an offence
under section 11 of the Statutory Declarations Act 1959, and I believe that the statements in this declaration are
true in every particular.
Date:
____________________________________
Signature of the Applicant:________________________
(To be signed in front of Notary Public or Justice of Peace)
Application for Grant of
Police Character Certificate from Pakistan
(to be filled in Capital Letters)
Part-C
Passport Size
Photographs of the
Applicant
The Ministry of Interior,
Government of Pakistan,
Islamabad.
I hereby request for issuance of a Police Character Certificate for the period from __________________
to ________________:
1
Name of the Applicant:
First:
Middle:
Last:
2
Father’s / Husband’s Name:
First:
Middle:
Last:
3
Date of Entry into Pakistan:
4
Purpose of Visit to Pakistan:
5
Passport Particulars
No.
Issued at:
Valid up to
6
Profession:
7
Date of Birth (DD-MM-YY)
-
-
Place of Birth:
8
Present Nationality
9
Former Nationality (if any)
10
Address (abroad)
11
Address (in Pakistan)
12
Visa Particulars
No.
Issued by:
Date of Expiry:
Type/Category:
13
Period of overstay (if any)
14
Residential Permit No. (if any)
Date of expiry
15
Last Date Extension Granted
(if any)
Authority /
Reference
Date: _______________
Signature:
________________________
Place:
________________________
