FORM F. L. /A-4

FORM F. L. /A-4

[See rules 68(1)]

Application for a special permit for privileged personages to possess and use foreign liquor for personal consumption

1. Name and address in full (surname first in BLOCK letters) ……………………………………
2. Whether the applicant is—
   • * (a) a sovereign or Head of a Foreign State;
   • * (b) an Ambassador or Diplomatic envoy of a Foreign State;
   • * (c) a Consul, Honorary Consul or Trade, Commerce or other representative of a Foreign State ; or
   • * (d) a member or the staff appointed by or serving under any person specified in clause (a), (b) or (c) and whether such member is national of a Foreign State or an Indian national; [Please state the official designation of the applicant and the name of the Foreign State, in each case, i.e. (a), (b), (c) or (d),] or
   • '[(d1) a member of a Foreign Government; or
   • *(d2) a representative or officer of an international organisation to which privileges and immunities are given from time to time by or under the United Nations (Privileges and Immunities) Act, 1947; or]
   • * (e) the consort of any person specified in clause (a), (b), (c), '[(d), (d1) or (d2)] (please state the name and official designation of such person); or
   • * (f) any relation of any person specified in clause (a), (b), (c), [(d1) or (d2)] dependent upon him; and if so, what is the relationship and with whom (please state the name and official designation of such person).
3. Nationality ……………………………………
4. Religion ……………………………………
5. Age ……………………………………
6. Permanent address ……………………………………
7. Maximum number of units of foreign liquor desired to be possessed at a time. ……………………………………
8. Period for which the permit is required. ……………………………………

I hereby undertake to abide by the conditions of the permit and the provision of the Bombay Prohibition Act, 1949, and the rules, regulations and orders made thereunder.

* Please strike off the unrequired items or words.

1. Added by G. N. of 18.9.1961.

2. Subs, ibid.

To,

The Collector of

(No fee is charged for this form)

Form of receipt

S. No. ___________

Received from ___________

of ___________
privileged personages.

an application for a Foreign Liquor Special Permit for

___________ when it may be obtained from

The permit will be ready on this office on presentation of this receipt.

(Reverse of the Application Form F.L./A-4)

Received the application on ___________

Permit to be ready on ___________

Permit prepared by ___________ on ___________

Permit checked by ___________ on ___________

Received permit No. ___________ on ___________

Seen. ___________

Filed. ___________ Signature of the permit-issuing authority.