FORM F. L. /A-1

762	Bombay Prohibition Act, 1949 [1949 : Bom. XXV
FORM  F. L. /A-1
[See rule  63(1)]
Application No.
Application for a permit to possess and use foreign liquor for
personal consumption by temporary resident
1.Name in full Mr./Mrs./Miss. .
(Surname first in block letters)
2.Residential address in full. .
3.Nationality	. .
4.Place of birth . .
5.Place where brought up. .
*6.Country of domicile . .
7.Number of the passport and the
authority which issued it.
8.Age	. .
9.Occupation	. .
10.Monthly income . .
11.Whether the applicant had applied
for any permit in the past and if so,
when and to whom.
12.Whether any member of the
applicant’s family has applied for
foreign liquor permit/s.If so,
details of each application/s should
be given.
13.Number of units of foreign liquor
required per month.
14.The date of arrival in India.. .
15.The period of residence or intended
residence in India.
I hereby declare that—
(a)I was born and brought up in/domiciled in . . . . . . . . . . . +;
(b)I am ordinarily using or consuming foreign liquor;
(c)I have been residing and intend to reside in India, temporarily;
(d)I have a fixed and settled purpose of making my sole and permanent home in
+ . . . . . . . . . . . . . . . . . .. which is outside India;
(e)Foreign liquor is being generally used or consumed in + . . . . . . . . . . . . .. . where I was
born and brought up or domiciled;
(f)I do not hold any permit under sections 40, 40A, 41, 46 or 47 of the Act nor have I
made any other application for a permit under any of these sections;
*Quote registration number and the office of registration under the Registration of Foreigners Act, if
the applicant is registered under the said Act.
+ State the names of the Country.
1 Ins. by 30-7-2008.

7631949 : Bom. XXV]	Bombay Prohibition Act, 1949
(ff)I have/have not been convicted on (dates) . . . . . . . . . . .. . . . . . . . . . at/any time of an/
any offence punishable under section/any provisions of the Bombay Prohibition Act,
1949.
There is a/is no prosecution under section/any provisions of the said Act pending
against me in the/any Court in 
1
[Maharashtra State].
(g)The particulars given above are correct.
I hereby undertake to abide  by the conditions of the permit and the provisions of the
Bombay Prohibition Act, 1949, and the rules, regulations and orders made thereunder.
Dated	Signatue of the applicant.
To
The Collector of
District ...........................
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Form of Receipt
S. No. . . . . . . . . . . . . . . .. .
Received from *
Name in full *
Address in full *
an application for Temporary Resident’s permit.
Signature of the Officer receiving
the application and date.
The applicant is requested to present this receipt personally on . . . . . . . . . . . .. . . .
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*To be filled in by the applicant.
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[Reverse of the application Form F. L./A-1]
(Not to be filled in by the applicant)
Action taken
Received the application.
Dated	Date of Registration
Called on	Permit prepared on
Checked by
Permit ready for delivery
Received the permit No. on
Signature of the applicant.
Seen
Filed
Signature of the permit-issuing authority.
1.Subs. by G. N. of 25-7-1963.