FORM F. L./A-6-B

FORM F.L./A-6-B

[See rule 70-D(2)]

Application No. ___________

Application for a permit for the purchase, possession, transport, use and consumption of Foreign Liquor and Country Liquor in the State of Maharashtra.

1. Name in full Shri/Smt./Kum. _________________________________________________________________
   (Surname first in Block letters)
2. Residential address in full ________________________________________________________________________
3. Age and date of birth _____________________________________________________________________
4. Details of proof of age produced with this application _____________________________________
5. Occupation ____________________________________________________________________
6. * * * * * * *

✵[I hereby declare that I require foreign liquor and country liquor on grounds of health and in support of my application. I submit herewith the medical certificate in Form F.L./M.C. I signed by Dr. _____________________________________________________________________________ Registered Medical Practitioner.]

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.

Place: ___________ Signature or thumb impression of
Date: ___________ the Applicant.

To
The Collector of _______________________
(or authorised Officer.)

✵[FORM F.L.X-B]

(Deleted)

✵[FORM F.L./A-6-C]

[See rule 70-F]

Application No. ___________

Application for a permit for the purchase, possession, transport, use and consumption of mild liquor in the State of Maharashtra.

1. Name in full .. Shri/Smt./Kumari __________________________________________
   (Surname first in block letters)
2. Residential address in full .. ________________________________________________________________

Footnotes:
1 Subs. by G. N. of 8-8-1979.
2 Deleted by G. N. of 4-5-1982.
3 Subs. ibid.
4 Deleted by G. N. of 8-8-1979.
5 Ins ibid.