FORM F. L. A-IE

"FORM F. L. A-IE 
(See rule 48A) 
Form of application for registration of premises to obtain a 
temporary license 
for a special function or event. 
1. Name of the 
premises. 
2. Name of the Owner/ Lessee (Legal Occupier) of the Premises. 
3. Whether the 
applicant is a resident of India or not. 
4. Address and details of the 
applicant. 
5. Exact Location and address of the 
premises 
6. Whether the 
premises holds on the date of this 
application 
or held at any time in the 
past any licence for the sale of foreign liquor and if 
so, the period during which it was held. 
7. Area of the entire 
premises in 
square meters. 
8. Area of the 
proposed premises with exact location where the applicant desires to sale/ serve liquor in 
square meters. 
9. If the 
premises is situated in Gram 
Panchayat area then, 
(a) if the 
population is more than 20,000 then whether it is within the distance of 500 meters, or 
(6) if the 
population less than 20,000 then whether it is within a distance of 220 meters; from the edge of the National or State Highway 
or the edge of the service road adjacent to such highway. 
10. Whether 
any excise/police/municipal licence held by the 
applicant is or was 
suspended 
or cancelled at 
anytime in the 
past, and if so, the period of 
suspension and, the reasons for such suspension. 
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 Maharashtra Prohibition Act [BOM. XXV of 1949| and the rules, regulations and orders made thereunder from time to time. 
Signature of the 
Applicant. 
Date 
To 
The 
Superintendent, State Excise 
of.... *****''* ** *** *****' ''*** 
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