FORM F. L. XII

7931949 : Bom. XXV]	Bombay Prohibition Act, 1949
FORM F. L. XII
[See rule 83 (10)]
                                                                                                        Licence No.
Licence for the dispensing of brandy and rum as one of the ingredients
of any medicine on prescription
Licence is hereby granted under and subject to the provisions of the Bombay
Prohibition Act, 1949 (Bom. XXV of 1949), and the rules, regulations and orders made
thereunder to ............................................... of ................................... (hereinafter referred to
as “the licensee”) on payment of a licence fee of Rs. ...................... authorising him to
dispense brandy or rum as one of the ingredients of a  medicine at his shop/dispensary
situated at ............................................ (hereinafter referred to as “the licensed premises”)
during the period from ........................................... to .................................. on the following
conditions, namely :
Conditions
1.(a)The licensee shall not keep in his possession any quantity exceeding
........................................ of brandy and rum, each at any one time.
(b)The licensee shall not purchase more than ............................. quart bottles of
brandy or rum, each during any calendar month.
2.The licensee shall not keep or dispense brandy or rum at any place other than
the licensee premises.*He shall not prescribe or dispense brandy or run except as one
of the ingredients of the medicine*.
3.The licensee shall not keep in the licensed premises any intoxicants which he is
not authorised to dispense under this licence or any other licence granted under any law
for the time being in force.
4.This licensee shall keep affixed to the licensed premises a signboard showing
the name of the licensed premises.
5.The licensee shall display the licence at a conspicuous place in the licensed
premises.
6.The licensee, his heirs, legal representatives or assignees shall have no claim
whatsoever to the continuance or renewal of this licence after expiry of the period for
which it is granted.It shall be entirely within the discretion of the Collector to permit or
not the assignee of the licensee in case of sale or transfer or the heir or legal representa-
tive of the licensee, in case of death, to have the benefit of the licence for the unexpired
portion of the term for which it is granted.
7.This licence may be suspended or cancelled in accordance with the provisions
of Section 54 or 56 of the said Act.
8.In case this licence is suspended or cancelled during the currency of the licence
period or is not renewed on its expiry, the licensee shall forthwith surrender to the
Collector the whole stock of unsold brandy and rum remaining in balance with him on
* Strike out where the licensee is not a registered medical practitioner.

794	Bombay Prohibition Act, 1949 [1949 : Bom. XXV
the date of such suspension, cancellation or expiration.The stock of liquor so
surrendered shall be sold by the Collector and the proceeds of the sale shall after
deducting the expenses and any sum due to the State Government be returned to the
licensee.
Place :
Dated :                                                                        Collector of .............................
Seal of the
Collector
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FORM ‘A’
[See rule 87 (6)]
Cash Memo
No.	Date
Name and address of the licenseeNo. of the licence in Form (F. L. XII)
Name and address of the person to whom Name and address of the person to whom
prescribed.	delivered.
Name and address of the Registered
Medical practitioner by whom prescribed.
Prescription	Foreign liquor prescribed
No. Date Kind Quantity Amount received
(1) (2) (3) (4) (5)
Rs. P. S.
Signature of the licensee or his
authorised agent or servant.