FORM F. L. /A-5

7751949 : Bom. XXV]	Bombay Prohibition Act, 1949
FORM  F. L. /A-5
[See rule  69(2)]
Application No.
Application for a Visitor’s  Permit to possess and use Foreign
Liquor for personal consumption
1.Name in full (surname first in BLOCK
letters).
2.Permanent address . . . .
3.Temporary address in the 
1
[State of
Maharashtra]. . .
4.Date of arrival in the State of
Maharashtra. . .
5.From where arrived and by which
train/boat/ari service.
6.Period of temporary stay in the
1
[State of Maharashtra].
7.Proposed date of departure and
place to which proceding.
8.Dates and duration’s of previous
visits to 
1
[Maharashtra State] dur-
ing the last twelve months.
9.Nationality.
10.State/Country of domicile.
11.Age.. . . . . . . .
12.Occupation . . . .
13.Quantity of foreign liquor required
14.Period for which the permit is
required.
15.If there is Prohibition in the State/
Country where the applicant
resides, he should state whether he
holds there any permit to possess
and consume foreign liquor, the
nature of permit and the monthly
quantity of foreign liquor allowed
thereunder.
1Subs by G. N. of 25-7-1963.

776	Bombay Prohibition Act, 1949 [1949 : Bom. XXV
I hereby declare that—
(a)I intend to reside in the State of Maharashtra for a temporary period only and that
i am only a visitor to the 
1
[State of Maharashtra].
(b)I am ordinarily using and consuming foreign liquor ;
(c)I do not hold any permit under section 40, 40-A, 41, 46, or 47 of the Act nor have I
made any other application for a permit under any of these sections;
(d)the particulars given above are correct.
I hereby undertake—
(i)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;
(ii)to furnish such information or proof in support of my declaration as may be
required now or hereafter.
Date
Signature of the applicant.
To
The Collector of ................................
The Prohibition and Excise/Police/Customs Officer.
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(Not to be filled in by the applicant)
Date of application
Permit prepared by
and issued on
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Received the permit No.      on
Signature of the applicant.
Signature of the officer
issuing the permit.
1Subs by G. N. of 25-7-1963.