FORM OF APPLICATION

The Collector; District

Sir;

I the undersigned residing at desire—

¹(1) to tap the neera-producing trees described in the schedule hereto and draw neera therefrom—¹

(a) for the manufacture of gur or any other article which is not an intoxicant;

(b) for the supply of neera —

(i) to person manufacturing gur or any other article which is not an intoxicant from neera; or
(ii) to person licensed to sell neera by retail for consumption on premises;
(c) for domestic consumption.

(2) to sell neera for consumption on premises and accordingly apply for the necessary licence.

²2. Number of members in my household who drink neera are—²

3. I hereby undertake to use the neera for the above mentioned purposes.

SCHEDULE

No. and kind of trees to be tapped	Situation of trees to be tapped	Owner's ^t[Proprietor's name and signature in token of his consent to the trees being tapped]^t	Remarks
(1)	(2)	(3)	(4)

^*[Retain only that which is necessary and cancel the remaining items.]^*

Place:

Signature of the Applicant

Date:

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