Sl. No. Name of The Verification Certificate Amount in Rupees Select Appropriate Service Sought

Karnataka State Police
APPLICATION FOR POLICE VERIFICATION/CLEARANCE CERTIFICATE
To
Passport
Size
The Commissioner of Police / Superintendent of Police / SHO Photo
_________________________ City / District / Police Station.
Karnataka.
Sir,
Sub: Application to issue Police Verification / Clearance Certificate for the

purpose of …..
Note: Please tick the appropriate one.
Sl. Name of the Verification Certificate Amount Select

No. in Rupees appropriate
service
sought
(1) (2) (3) (4)
1. Police Verification Certificate (PVC/PCC) for Job Purpose 300/-
to MNCs/Private Sector/ Corporate & other companies
ANTECEDENTS VERIFICATION ONLY (as per police station
records)
2. Police Verification Certificate (PVC/PCC) for Job Purpose 1000/-
to MNCs/Private Sector/ Corporate/ & other companies
ANTECEDENTS VERIFICATION along with 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 / 500/-
House Keeping ANTECEDENTS VERIFICATION along with
ADDRESS VERIFICATION.
6. Police Verification Certificate of Institutions /Companies 1,000/-
ANTECEDENTS VERIFICATION along with ADDRESS
VERIFICATION.
7. Police Verification Certificate for Marriage Alliances 300/-
ANTECEDENTS VERIFICATION.
8. Police Verification Certificate for training/Apprenticeship 50/-
at Public sector undertakings or for Trainees / Workers
working on daily wages at Government Institutions.
9. Police Verification Certificate for NCC / NSS Students 50/-
attending training camps ANTECEDENTS VERIFICATION.
10. Police Verification Certificate for Coolie / Loader / Class 100/-
IV security staff / supervisor at Airport. (Individual
applicants only) ANTECEDENTS VERIFICATION.
11. Police Verification Certificate for Central / State 250/-
Government Employees request directly by employee.
12. Police Clearance Certificate (PCC) for going abroad (Visa 200/-
for studies)/Immigration purpose also for obtaining green
card.
13. a) Verification and comparison of Finger Print – Fees for 500/-
each verification b) Fees for extra 10 certified copies 500/-
14. Police Clearance Certificate for Indian Citizens/For 200/-
accepting or Donating Kidney/Adoption of child/For
purchase of property in other states/for business
purposes.
1. Verification of service local Jurisdiction.

2. Verification of service outside Jurisdiction.
3. Any other purpose
The verification done through Department as per Government Order’s: -
(1) (2) (3) (4)

1. PIO / OCI Cards As per Govt. Order As per Govt
Order
2. Pakistan Visa As per Govt. Order As per Govt
Order
3. Verification of Citizenships As per Govt Order As per Govt
Order
4. Government Employees Job Verification done through As per Govt
Order
In case the fee is paid in BangaloreOne / KarnatakaOne service charges as

applicable is to be paidadditionally
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
4. Date of Birth & Age Years d d m m y y y y

5. Present
Address
a. Period of stay
6. Permanent
Address
7. Address
needs
to be verified
with period of
stay.
a. Period of stay
(Enclose additional sheet for more than one address)
8. 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.)
.
(b) Treasury / Bank: ( Pl enter the challan Number )
Original Challan / Receipt has to be enclosed

11. Do you possess a passport Yes No
If yes furnish particulars as below
b. Date of issue
a. Passport Number
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 ANTECENDENTS 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, Aadhar Card)
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.

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Karnataka State Police

APPLICATION FOR POLICE VERIFICATION/CLEARANCE CERTIFICATE

Sub: Application to issue Police Verification / Clearance Certificate for the

Note: Please tick the appropriate one.

Sl. Name of the Verification Certificate Amount Select

1. Verification of service local Jurisdiction.

3. Any other purpose

The verification done through Department as per Government Order’s: -

(1) (2) (3) (4)

In case the fee is paid in BangaloreOne / KarnatakaOne service charges as

4. Date of Birth & Age Years d d m m y y y y

(Enclose additional sheet for more than one address)

8. 8. Name of the Jurisdiction Police

9. Contact telephone Number. (a) Land line (b) Mobile.

10. Details of fee remitted:

(b) Treasury / Bank: ( Pl enter the challan Number )

Original Challan / Receipt has to be enclosed

c. Validity d. Place of issue

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