FORM F. L. /A-1

FORM F.L./A-1

[See rule 63(1)]

Application for a permit to possess and use foreign liquor for personal consumption by temporary resident

Application No. ___________

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—

1. I was born and brought up in/domiciled in ___________*;
2. I am ordinarily using or consuming foreign liquor;
3. I have been residing and intend to reside in India, temporarily;
4. I have a fixed and settled purpose of making my sole and permanent home in ___________, which is outside India;
5. Foreign liquor is being generally used or consumed in ___________, where I was born and brought up or domiciled;
6. 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.

(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 '[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.

To
The Collector of
District ___________________

Form of Receipt

S. No. _____________

Received from *
Name in full *
Address in full *
an application for Temporary Resident's permit.

The applicant is requested to present this receipt personally on _____________

*To be filled in by the applicant.

[Reverse of the application Form F. L./A-1]
(Not to be filled in by the applicant)

Action taken

Received the application.
Dated _____________________
Called on _____________________

Date of Registration _____________________
Permit prepared on _____________________
Checked by _____________________
Permit ready for delivery _____________________
Received the permit No. on _____________________
Signature of the applicant. _____________________

Seen _____________________
Filed _____________________

1. Subs. by G. N. of 25-7-1963.