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; 
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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. 
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