APPLICATION FOR NON-CONVICTION CERTIFICATE Passport Size Photo attested by GO No. / SP (HQ)/SWS/NCC/2007-08 Dated .......... 1. Name of the applicant : (in BLOCK Letters as in Birth Certificate 2. Son/ Daughter/Wife of : 3. Date of Birth and Age : (Attested copy of Birth Certificate to be enclosed) 4. Present address : (For proof of residence attested copy of Ration Card/Residence Certificate to be enclosed) 5. Police Station Limit : 6. Telephone Number and Cell Phone : Number 7.. Since when the applicant is residing : in the present address. If he/she resided in some other place(s) previously, give details with date(s) 8. Purpose for which the Non-: Conviction Certificate is applied for (Name of the country proposed to visit) 9. Authority to whom the NCC is to be : French Consulate/Regional produced Passport office 10. Whether the applicant is a govt. : Govt. Servant/Private Employee Servant/ Private employees? 11. If the applicant is a Govt. Servant, : enclose a copy of No Objection Certificate issued by the Competent Authority Note: Please enclose 2 copies of Passport size photos on each application in a small cover. Date: Signature of the Applicant FOR OFFICE USE (A) Forwarded to SP (South) / (North) / (Rural) for verification of the applicant's criminal antecedents. (B) Forwarded to SP (Special Branch) for verification of the applicant's character for security clearance. (C) Forwarded to SP (CID) for verification in the records of CRB. The above Officers are requested to send their replies by.......... SUPERINTENDENT OF POLICE (HQ) PUDUCHERRY
