FORM T.D–1

FORM 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—
   1. (i) is a resident of the locality where the licensed shop is proposed to be located;
   2. (ii) belongs to a Scheduled Tribe (mention the name of the Scheduled Tribe); and
   3. (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—
   1. (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 another;
   2. (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;