FORM T. R. T. D-1

FORM T. R. T. D-1 (See rule 4) Form of Application for a Licence to sell Toddy by retail I/We hereby apply for a licence/renewal of licence for the retail sale of Toddy. The necessary particulars are mentioned below : 1. Name and address of the applicant and registration number if the applicant is an Adivasi Co-operative Society. 2. Names and addresses in full of the partners, if any. 3. The address in full of the premises where the Toddy would be sold. 4. Whether the applicant— (i) is a resident of the locality where the licensed shop is proposed to be located; (ii) belongs to a Scheduled Tribe (mention the name of the Scheduled Tribe); and (iii) Owns any Toddy trees in the area (specify the name (s) of the village (s) and the number of trees). 5. Whether the proposed premises referred to at item 3 above are— (a) Situated within a distance of 75 metres from any industrial undertaking or irrigation or other developmental project where 200 or more workmen are employed in one or more shifts either in a single undertaking or project or in a group of undertakings or projects located near one an- other; (b) Situated within a distance of 75 metres from the boundary of any National or State Highway and visible from the entrance of which is facing such Highway; 207 208 Bombay Prohibition Act, 1949 [1949 : Bom. XXV (c) Situated within a distance of 75 metres from any educational in- stitution; students’ hostel run or recognised by the Social Welfare Department or attached to an educational institution, public or private maternity home, public hospital, religious institution, colony of labourers or of Harijans; and (d) Situated within a distance of 200 metres from any Maharashtra State Road Transport Corpora- tion, Bus Stand or Station or Depot and visible from the entrance of which is facing, such Bus Stand or Station or Depot. 6. Whether the applicant or any member of his family (or any of the partners ) holds at present or held at any time in the past (individually or in partnership with any other person) any excise licence (s) and if so, indicate the particulars of such licence (s) held and also the period (s) for which held. 7. Proof of solvency. 8. Present occupation and income therefrom. 9. Whether any Excise/ Police/ Municipal / Food and Drugs licence held by the applicant is or was suspended or cancelled at any lime in the past, and if so, the period of such suspension or cancellation and the reasons therefor. 10. Whether the applicant is in arrears & excise or any other Government dues. 1949 : Bom. XXV] Bombay Prohibition Act, 1949 I/We hereby declare that the particulars given above are correct. I/We enclose a Challan No......................................, dated ........................... evidencing payment of a sum of Rupees l5 (Rupees fifteen) for the application. I hereby undertake to abide by the conditions of the licence and the provisions of the Bombay Prohibition Act., 1949, and the rules, regulations and orders made thereunder from time to time. Date : ............................... ………………………….. Signature of the Applicant. To, * The Secretary to the Government of Maharashtra, Home Department , Mantralay, Bombay 400 032 (Through the Collector of. ......................................................................). † The Collector of......................... ———————————————————————————————————— * When application is for grant of a licence, † When application is for renewal of a licence. 209