FORM F. L. X-C

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 _________________________

Date: _________________________

Signature of the Registered Medical Practitioner and his name and Registration No.
_________________________

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 county 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: _________________________

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 county liquor for preservation and maintenance of my health.

Place: _________________________

Date: _________________________

1. Ins. by G. N. of 8-8-1979.