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Postage StampRs 10/- PHOTO(Application Form for Foreigners)Additional Inspector General of Police, Police Headquarters, Crime Investigation Department, Naxal, Kathmandu Subject: Request to Provide Character CertificateDear Sir/Madam,I, hereby, submit the application for Character Verification Certificate and certify that the information provided herein are true. I have attached the necessary documents for verification. I fully understand the consequences of providing the false information.Note: - Use Capital Letters only1. Full Name: - Mr. / Mrs. / Miss…………………………………………………………………………………………………………..2. Father / Husband’s Name: - Mr. ……………………………………………………………. 3. Male/Female: - ……………..4. Nationality: - ………………..5. Date of Birth: - A.D………………………………………………….6. Permanent Address: - Country……………… Province/State…………………City…………….…Street/Zip code ……………7. Temp. Address (In Nepal): - District ……...…………Metro./Sub Metro/Muni./V.D.C………………………Ward No….. 8. Passport No: - ……………………………Issuing Country: - ……………………………………………........................9. Passport Issuing Date: - ……………………..Expiry Date:-…………………………………………………………………….10. First Visa Issuing Place: - …………………. Issuing Date: - ……………Expiry Date: - ……………Type:- ………………11. Current Visa Issuing Place: - …………………. Issuing Date: - ……………Expiry Date: - ……………Type:- ………………12. Stayed period in Nepal: - From………………………………..To………………………………………………………13. Relation with Applicant (For Foreigner stayed in Nepal): - ……………………………………………………………………Applicant (Relative/Organization) Applicant's Finger PrintSignature: - Name: - Date: - Phone No. /Email Address:- Right Left For Official Use Only Centre: - Registration No.:- Distribution No.:-Certifying Authority (Registration Centre Head)Record Examiner (CRS)Final Examiner (Character Verification Section)Name and Designation :-Name and Designation :-Name and Designation :-Signature:-Signature:-Signature:-Result:-CorrectIncorrectSignature of Section HeadSignature of Section HeadPostage StampRs 10/- PHOTO (Application Form for Refugees)Additional Inspector General of Police, Police Headquarters, Crime Investigation Department, Naxal, Kathmandu Subject: Request to Provide Character CertificateDear Sir/Madam,I, hereby, submit the application for Character Verification Certificate and certify that the information provided herein are true. I have attached the necessary documents for verification. I fully understand the consequences of providing the false information.Note: - Use Capital Letters only1. Full Name: - Mr. / Mrs. / Miss …………………………………………………………………………………………………………..2. Father / Husband’s Name: - Mr. …………………………………………………………………………………………………… 3. Male / Female: - ……………..4. Nationality: - ………………..5. Date of Birth: - A.D………………………6. Permanent Address: - Country……………… Province/State…………………City……………. Street/Zip code ……………… 7. Address in Nepal: - District …………………Metro. /Sub. Metro/Muni./V.D.C…………………………………Ward No……… 8. Refugee ID No/ Card No: - ……………………………. Issuing Office:-……………………………………………….9. Travel Document/Passport No: - ………………..…… Issuing Country: - ………………………………………......................10. Travel Doc/Passport Issuing Date: - ……………………..Expiry Date:-……………………………………………………….11. Stayed Period in Nepal: - From………………………………..To………………………………………………………Applicant (Relative/Organization) Applicant's Finger PrintSignature:-Name:-Date:-Phone No/Email Address:- Right LeftFor Official Use OnlyCentre: - Registration No.:-Distribution No.:-Certifying Authority (Registration Centre Head)Record Examiner (CRS)Final Examiner (Character Verification Section)Name and Designation :-Name and Designation :-Name and Designation :-Signature:-Signature:-Signature:-Result:-CorrectIncorrectSignature of Section HeadSignature of Section Head ................
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