APPLICATION FORM FOR PCC 02/04/25, 10:31 PM
EMBASSY OF INDIA
RUA PERO DA COVILHA, NO. 16, RESTELO, 1400-297, LISBON, PORTUGAL
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APPLICATION FORM FOR POLICE CLEARANCE CERTIFICATE
Generated On: Wednesday, April 2, 2025
10:30:43 PM
SERVICE REQUIRED
Application Reference Number 25-2001769192
Purpose of PCC RESIDENCE PERMIT
Country for which PCC is required PORTUGAL
PASSPORT DETAILS Paste your unsigned
Passport Number C8685096 recent color
Date of Issue (DD/MM/YYYY) 17/02/2025
Date of Expiry (DD/MM/YYYY) 16/02/2030 photograph Size
Place of Issue LISBON
File Number PG0075445564925 2"X2"
APPLICANT DETAILS
Note: Please paste your unsigned recent color
photograph Size 2"X2" and Signature/Left
Hand Thumb Impression in the box provided
above.
Applicant's Name SOBIN
Date of Birth (DD/MM/YYYY) 06/04/1997
Place of Birth (Village/Town/City) NAKODAR PUNJAB
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
PAN GPKPS4089Q
Voter Id
Educational Qualification 7TH PASS OR LESS
Employment Type NOT EMPLOYED
Organisation name
Aadhaar Number 347476547059
FAMILY DETAILS
Father's Name CHARANJIT
Mother's Name VEENA RANI
Legal Guardian's Name
Spouse's Name PRIYA
PERMANENT ADDRESS IN INDIA
4805, ASHOK VIHAR COLONY NAKODAR,
Address
NAKODAR CITY Jalandhar Rural, Punjab
PIN 144040
Mobile/Tel No. 9815424198
E-mail
[email protected] PRESENT ADDRESS IN COUNTRY OF DOMICILE
RUA ENG BERNARDO VILA NOVA 20, ALCOBACA
Address
2460-044, Portugal
Mobile/Tel No. 00351912354777
OTHER DETAILS
1) Provide the following details if there are any criminal proceedings pending against the applicant.
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APPLICATION FORM FOR PCC 02/04/25, 10:31 PM
1.1) Are any proceedings in respect of an offence alleged to have been committed by you pending before a criminal court in India? N
Court Name and Place
Case/FIR/Warrant Number
Law and Section(s)
1.2) Has any warrant or summons for your appearance been issued and pending before a court under any law for the time being in force? N
Court Name and Place
Case/FIR/Warrant Number
Law and Section(s)
1.3) Has a warrant for your arrest been issued by a court under any law for the time being in force? N
Court Name and Place
Case/FIR/Warrant Number
Law and Section(s)
1.4) Has an order prohibiting your departure from India been made by any court? N
Court Name and Place
Case/FIR/Warrant Number
Law and Section(s)
2) Provide the following details if the applicant has been convicted by a court in India.
2.1) Have you at any time during the period of five years immediately preceding the date of this application been convicted by a court in India for any criminal
N
offence involving moral turpitude and sentenced in respect thereof imprisonment for not less than 2 years?
Court Name and Place
Case/FIR/Warrant Number
Date of Conviction
SELF DECLARATION
I owe allegiance to the sovereignty, unity & 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. I have not contravened any of the conditions relating to the possession and use of an Indian passport.
I affirm that the information and particulars given by me in this form are true and correct. I further state that I am not suppressing any material information in this
regard. I further affirm that the enclosures and documentary proof submitted in support of my application for an Indian passport are authentic and solely pertain to me
and I am fully responsible for the accuracy of the same. 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.
I have read and understood the contents of the above and by submitting this form certify that all the information submitted by me in the form is bonafide.
Place LISBON
Signature/Left Hand Thumb Impression of Applicant
Date 02/04/2025
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