FORM F. L. /A-7

FORM F.L. /A-7

(See rule 71)

Application No. ___________

Application for a licence to possess and use brandy and rum by industrial, educational, scientific, research or such other institution or by a pilot of an air-craft or by a person in charge of ambulance or a first-aid station for rendering first-aid or for medicinal purpose in an emergency.

1. Name, designation and address of the applicant in full.
   (Surname first in BLOCK letters.)
   ___________________________________________________________________________
2. Name and address of the institution*
   ___________________________________________________________________________
   No. of the ambulance and the name and address of the institution to which it belongs name and address of the 'first-aid station'*
   ___________________________________________________________________________
   Name or No. of the Air-craft* …
   ___________________________________________________________________________
3. Age.
   ___________
4. Occupation.
   ___________________________________________________________________________
5. Quantity of brandy and rum required during a month.
   ___________________________________________________________________________

I hereby declare that the particulars given above are correct.

I hereby undertake to abide by the provisions of the Bombay Prohibition Act, 1949, and the rules, regulations and orders made thereunder and the conditions of the licence.

Date : ___________

To,

The Collector of _______________

* Strike out where not applicable.