FORM F. L. M. C.-2

7891949 : Bom. XXV]	Bombay Prohibition Act, 1949
1
[FORM F. L. M. C.-2]
(See rule 70-F)
(For applicants in Wardha District only)
Application Form  F. L./A. 6-C No. ........................................
Certificate of Registered Medical Practitioner recommending the grant of permit to
possess and use mild 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 mild
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	Signature of the Registered Medical
Practitioner and his name and
Date :	Registration No.
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1
[FORM   F. L. X-C
(See rule 70-D)
No.
Shri/Smt./Kum. ......................................... age ................................ residing at
...................................................... is hereby permitted to purchase, possess, transport,
use and consume foreign liquor and country liquor within the State of Maharashtra,
subject to the provisions of the Bombay Prohibition Act, 1949, and the rules, regulations
and orders made thereunder, during the period commencing on the date on  which this
permit is granted and ending on .............................................
Place :
Date :
Seal of the Office	Signature of Officer.
Specimen Signature or thumb
impression of the permit-holder.
(To be filled in and handed over to the Officer issuing permit for grant of permit for
subsequent period).
-------------------
I declare that, I continue to require foreign liquor and country liquor for preservation
and maintenance of my health.
Place :
Date :	Signature or thumb impression
of permit-holder.]
1.Ins. by G. N. of 8-8-1979.