FORM F. L./A. 6-C

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.

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 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.

FORM F.L./A.6-D

(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:

Station

Date: _________________

Notes:
1. Ins. by G. N. of 8-8-1979.
2. Subs. by G. N. of 4-5-1982.