[See clause 4]
*I/We am/are holding in my name/our names in the name of the firm/private company more than one scheduled licence, the particulars whereof are given below:
| Kinds of scheduled licences held |
Name in which the licences is granted |
Licensing authorities granting them |
| (1) |
(2) |
(3) |
*I/We declare that I am a member/we are members of a family unit and the said family unit holds the scheduled licence (s), the particulars whereof are given below:
| Kinds of scheduled licences hold |
Name of the family unit and its adult members |
Name in which the licence is granted |
Licensing authorities granting them |
| (1) |
(2) |
(3) |
(4) |
*I/We further declare that out of the scheduled licences held by me/us in my name our names in the name of firm/private company. I/We opt for the renewal or re-grant of the following single scheduled licence.
(Here describe the scheduled licence opted for renewal or re-grant)
*I/We further declare, in pursuance of the authority given by the aforementioned family unit, that the said family unit has opted for the renewal or re-grant of the following single scheduled licence.
(Here describe the scheduled licence opted for renewal or re-grant)
*I/We further declare that the particulars given above are true to the best of my/our knowledge and belief and that I am/are liable for action for making a wilful misrepresentation, if the information given above is found subsequently to be false.
Address of the person communicating the option. Signature of the person communicating the option.
- To be struck off, if not applicable.
Note.—
- Not more than one scheduled licence will be renewed or re-granted to the licensee.
- If no option is communicated to the Commissioner of Prohibition and Excise, Maharashtra State, Old Customs House, Fort, Bombay, before 29th February 1980, none of the scheduled licences held by the licensee shall be renewed or re-granted.