FORM F. L./A-6

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 '[State of Maharashtra,] if the applicant is not a permanent resident in the '[State of Maharashtra.]
4. Period of stay; in the '[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 '[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 applicant 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.

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

FORM F.L./A-6

Application for Health Permit, Temporary Resident's Permit or Special Permit for Privileged Personages

1. 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.
2. 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.

To,

The Collector ___________

The Prohibition and Excise/Police/Customs Officer-in-charge.

* strike off clauses which are not applicable.

| *    *            *            *            *            *

[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 ___________

Forwarded to the Superintendent of prohibition and Excise, for disposal.

Prohibition and Excise

Police ___________ Officer-in-charge.

Customs.

1 Deleted by G. N. of 8-7-1969.