CRIMINAL HISTORY RECORD

No. ***                                                                         21 Oct 2008

RECIPIENT : OOO

TITLE : Police Record & Investigate History Report

□ PERSONAL INFORMATION OF INQUIRY

NAME		SEX
RESIDENT REGISTRATION NUMBER		PURPOSE	SELF IDENTITY
RANG OF INVESTIGATING	CRIME HISTORY
ADDRESS

□ INQUIRY RESULT

No	PROSECUTE DATE	PROSECUTE PUBLIC OFFICE	THE NAME OF A CRIME	PUNISHMENT DATE	PUNISHMENT PUBLIC OFFICE	PUNISHMENT RESULT	etc
1			Not Applicable

No criminal conviction history has been found.

This is to certify the above information is true and correct.

Chief of OOO Police Station