FORM D

854 	Bombay Prohibition Act, 1949 	[1949 : Bom. XXV 
 
1
 [ FORM ‘D’ 
(See rule 5) 
Form of application for a licence to sell 
6
mild liquor, or 
6
[wines or both] 
1. Name and address of the applicant . 
 
2. Names and addresses in full of the partners, 
if any. 
 
3. Name of the Hotel/Restaurant/Club/Canteen 
and its address in full, i.e.its exact location. 
 
2
[4. Whether the hotel, restaurant or canteen 
is within a distance of seventy five meters 
from any educational or religious institution 
or from any bus stand, station or depot 
of the Maharashtra State Road Transport 
Corporation.] 
 
5. Whether the applicant holds at present or 
held at any time in the past any licence for 
the sale of foreign liquor including mild 
liquor, and if so, the period during which it 
was held. 
 
6. Average number of residents/boarders/ 
members or visitors, as the case may be, 
during the last one year immediately before 
the date of the application. 
 
3
[7.(a) The details of amenities provided at the 
hotel/restaurant/canteen/club and in the 
case of a club the objects and activities 
thereof,] 
 
(b) 
4* 	* 	* 
* 
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[(c) Carpet area of hotel/restaurant/canteen 
where consumption of mild liquor will 
be allowed and how many persons are/can 
be provided with sitting accommodation at 
a time, 
 
1. Ins. by G. N. of 1-12-1971. 
2. Subs. by G. N. of 25-3-1981 
3. Subs. by G. N. of 30-12-1976. 
4. Deleted by G. N. of 25-3-1981. 
5. Subs. by G. N. of 30-3-1977. 
6. Ins. by 28-12-2001.

1949 : Bom. XXV] 	Bombay Prohibition Act, 1949 
 
(d) What is the carpet area of the hotel/ 
restaurant/canteen excluding kitchen, 
clock-room, etc., which is not used for 
customers ? 
(e) Whether the establishment has a separate 
kitchen, and attached clock-room provi- 
ding wash-basin & urinal facilities ; 
(f) Whether the establishment has provision 
for serving snacks, eatable etc.; 
(g) Whether the establishment has separate 
store room adjacent to the proposed 
licensed premises for storage of mild liquor 
2
[or wines or both.] 
8. The grade, if any, in which the hotel/ 
restaurant/club/canteen is classified and 
the authority for such classification, if 
any. 
8A. 
1
* * * * * * 
9. Proof of solvency of the applicant. 
10. Whether any Excise/Police/Municipal 
Licence held by the applicant was sus- 
pended or cancelled at any time in the 
past, and if so, the period of such sus- 
pension or cancellation and the reasons 
therefor. 
11. Whether the applicant is in Excise arrears 
or in arrears of any other Government dues, 
such as Sales Tax, Income Tax etc. 
I, hereby declare that the particulars given above are correct. 
I, hereby undertake to abide by the conditions of the licence and the provisions of the 
Bombay Prohobition Act, 1949, and the rules, regulations and orders made there- under 
from time to time. 
855

Date : 	Signature of the applicant 
To 
The Collector of ........................................ ] 
 
 
1. Deleted by G. N. of 25-03-1981. 2. Ins. 
by 28-12-2001.