FORM F. L./A. 6-C

7871949 : Bom. XXV]	Bombay Prohibition Act, 1949
1
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)
2
* * * * * * *
3
[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.)]
-------------------------
4
[FORM F. L. X-B]
(Deleted)
5
[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)Residental address in full. .................................................................................
Court Fee
Stamp
Court Fee
Stamp
1Subs. by G. N. of 8-8-1979.	2Deleted by G. N. of 4-5-1982.
3Subs. ibid.	4Deleted by G. N. of 8-8-1979.
5Ins ibid.

788	Bombay Prohibition Act, 1949 [1949 : Bom. XXV
(3)Age and date of birth. .................................................................................
(4)Particulars of proof of age. .................................................................................
produced with the application
(5)Occupation . .................................................................................
* I hereby declare that I require mild liquor for the preservation and maintenance of my
health.
I sumbit herewith the medical certificate in Form  F. L. M. C.-2 signed by Dr. ...................
...................Registered Medical Practitioner, in support of my application.
I hereby undertake to abide by the conditions of the permit and the provisions of the
Bombay Prohibition Act, 1949 and rules, regulations and orders made thereunder.
Place :
Date :	Signature or thumb impression
of the applicant.
To,
The Collector of ................................
(or authorised Officer).
*[for applicants in Wardha District only].
-------------------------
1
[FORM F.   L./M.C-D1
2
[(See rule 70-D)]
Application Form  F. L./A-6D No. ...............................................................................................
Certificate of a Registered Medical Practitioner/Government Medical Officer
recommending the grant of permit to possess and use foreign liquor
and country liquor for personal consumption.
This is to certify that Shri/Smt./Kum. ................................................................................ of
...................................................... by his/her statement aged .....................................................
years and is apparently about ............................................. years of age and that he/she
requires foreign liquor and/or country liquor for the preservation and maintenance of
his/her health.The grant of the permit to him/her is recommended.
Signature or thumb impression
of the applicant .........................................
Full address of the applicant :
Signature of the Registered Medical
Practitioner and his name and
Station	registration number.
Date :	Signature and Designation of a Govern-
ment Medical Officer and his name.]
1.Ins. by G. N. of 8-8-1979.	2.Subs. by G. N. of 4-5-1982.