FORM NO. C.I. W. I

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546

Bombay Prohibition Act, 1949 [1949 : Bom. XXV

FORMNO.C.I.W.I
(See Rules 3)
APPLICATION FOR LICENCE FOR IMPORTAND SALES BY WHOLESALE OF
COUNTRY LIQUOR
(1) Name or names and address or addresses of
the person or person applying, if the applicant is a
firm the name are address of every partner of the
firm and if a company, the registered name and
address thereof, the names of the Directors,
managers and Managing Agents, and if there is a
managing Director, his name.

(2) Location of the shop or premises where the
applicant wants to sell imported Country Liquor
with census number of the house or building, name
of street, village, town or city, as the case may be.

(3) Where the person or any partner of the firm
or the Director, Managing Director, Manager or
managing Agent of a Company is/was holding any
Excise Licence, if so state the kind of licence held
and the duration of the licence.

(4) Whether any excisable articles are/were
stored in the premises proposed for location of the
licence and if so, give full details.

(5) Certificate from the Municipality /
Grampanchayat, etc. to the effect that it has no
objection to locate the licenced premises in the
concerned locality.

(6) Does the applicant agree to give an
undertaking in writing to abide by the provisions of
the Act, and the rules, regulations and orders made
thereunder and conditions of the licence applied for.

(7) Whether the applicant has been convicted
at any time of an offence punishable under any of
the provisions of the Bombay Prohibition Act, 1949,
or any Rules, Regulations or Orders made

thereunder.
I/ We hereby declare that the particulars given above are correct. I/We enclose a
Chalan No. .........................------ , ध्यात तघ[20 ................................................. as an evidence for

the payment of a sum of Rs. 25 (Rupees twenty five only) for the application.

I/We hereby undertake to abide by the conditions of the licence and the provision of
the Bombay Prohibition Act, 1949, and the rules, regulations and orders made thereunder
from time to time.

1)वॉट................................. हाण,
171806 .......................................... ८८.८... ८.८...
Licensee.
Signature of the Applicant.
To

The Secretary to the Government of Maharashtra,
Home Department, Sachivalaya, Bombay
(though the Collector 0ी............................. )