FORM F. L./M.C-D1
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.
See rule 70-D
FORM F. L./M.C-D1
[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 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 registration number.
Station
_________________________________________________
Date: _____________________
Signature and Designation of a Government Medical Officer and his name.
1. Ins. by G. N. of 8-8-1979. 2. Subs. by G. N. of 4-5-1982.