PERSONAL DATA
個人資料
(For Official Use Only 本欄不用填寫)
APPLICATION FOR CERTIFICATE OF NO CRIMINAL CONVICTION
無犯罪紀錄證明書申請表
I, the undersigned, hereby make application to the Commissioner, Hong Kong Police Force for a Certificate of No Criminal Conviction: -
本人，下列署名者，現向香港警務處處長提出申請無犯罪紀錄證明書: -i. 請用黑或藍筆以正楷填寫本申請表
Please complete this form in Block letters using black or blue pen.
ii 請在適當空格內填上剔號「 」    Please tick as appropriate （ ）
Note: Applicants for Certificates of No Criminal Conviction should familiarize themselves with the "Notes to Applicants" which contain the terms and conditions for the issue                    of Certificates of No Criminal Conviction.
注意事項: 申請無犯罪紀錄證明書的人士應該熟悉『申請人須知』內所述有關無犯罪紀錄證明書的簽發件和情況。
Date:  日期:
(YYYY/MM/DD)
Applicant Signature: 申請人簽署:
本欄由辦理機關處理 For Official Use Only
費用收妥 Fee received
職員姓名、職位及簽署
Name, Post Title and Signature of Officer
Pol. 172A (Rev 01/2022)
CNCC NO.printform
Date: 日期:
請列印有關表格並謹記於列印的表格上簽署才遞交。
Please print the filled form and remember to sign it before submission.

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