FORM F. L./A-6

7791949 : Bom. XXV]	Bombay Prohibition Act, 1949
FORM  F.  L./A-6
[See rules  70(1)]
Application No.
Application for an interim 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,] if the
applicant is not a permanent
resident in the 
1
[State of
Maharashtra.]
4.Period of stay; in the 
1
[State of
Maharashtra,] if temporary.
5.Nationality . .
6.Place of birth. .
7.Place where brought up . .
8.Country of domicile. .
9.Number of passport and the
authority which issued it, if the
applicant is not a permanent
resident in the 
1
[State of
Maharashtra].
10.Date of arrival in India if the
applicant is a temporary
resident or is a person falling
under   section 41 of  the Act.
11.Period of residence or intended
residence in India, if the appli-
cant is a temporary resident or
a person falling under section
41 of the Act.
12.Purpose of his visit to India, if
the applicant is a temporary
resident or a person falling
under section 41 of the Act.
13.Age . .
14.Occupation. .
15.Religion. .
16.Number of units of foreign
liquor required per month.
1Subs. by G. N. of 25-7-1963.

780	Bombay Prohibition Act, 1949 [1949 : Bom. XXV
17.The kind of permit the applicant
has applied or is applying for,
that to say, whether a health
permit, temporary resident’s
permit or special permit for
privileged personages.
18.Period for which the interim
permit is required.
I hereby declare that—
* (a) (i)I require foreign liquor for the preservation or/and maintenance of my health.
* (ii)I am a temporary resident ;
* (iii)I am eligible for a permit under section 41 of the Act ;
* (b)I am ordinarily using and consuming foreign liquor ;
* (c)Foreign liquor is being generally used or consumed in the country where I was
born and brought up or domiciled ;
(d)I do not hold any permit under section 40, 40-A, 41,  46, or  47 nor have I made any
other application for an interim permit ;
(e)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.
Signature of the applicant.
Date :
To,
The Collector  ............................................................................
The Prohibition and Excise/Police/Customs Officer-in-charge.
--------------------------------------------------------------------------------------------------------------------
*strike off clauses which are not applicable.
1
 * * *	* * *
[Reverse of Form F. L./ A-6]
(For office use only)
Date of application :
Registration No. :
Permit prepared by .............................................  and issued on  ..............................................
Received the permit No.   .....................................
on ..................................... ........................................
Signature of the applicant.
Forwarded to the Superintedent of prohibition and Excise, for disposal.
Prohibition and Excise
Police  ........................... Officer-in- charge.
Customs.
1Deleted by G. N. of 8-7-1969.