Criminal Record Clearance Form

Criminal Record Clearance Form

Fill in the below form as comprehensively as possible
1. Do you have a criminal record?

Yes No Not sure
2. Have 10 years lapsed since you have been convicted? *

Yes No Not Sure
3. Have you served any jail time?

Yes No
4. Did you pay a fine?

Yes No
5. Was the fine more than R20,000

Yes No
6. Have you been convicted of any other offence and sentenced to a period of imprisonment without the option of a fine during those 10 years? *

Yes No
7. Have you been convicted of a sexual offence against a child or person who is mentally disabled, or of an offence where you were found to be unsuitable to work with children? *

Yes No
8. What is the reason that you want your criminal record expunged/cleared?
Please select one of the options from the drop-down menu above
9. It 'Other' was selected from the dropdown menu above, kindly explain below
Personal Details

Please fill in ALL the field below
Names

Full Names as per ID document Surname
Identity Number
Residential Address

Street Address

Street Address Line 2

City Province

Postal Code
E-mail Address
Provide your email address here
Phone Number
Please enter a valid phone number.
Already have Police Clearance Certificate. Please scan and upload for us to assess. Also Upload copy of Identity Document.

Cancel of
By sending this questionnaire to us you hereby confirm that the information contained in this form is within your personal knowledge true and correct.

Yes, the information I provided here is true and correct to the best of my knowledge
Should be Empty:

Criminal Record Clearance Form

Personal Details