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3. I/We hold licence No for constructing and working a distillery for the manufacture of spirit valid up to ¹[Or/I/We hold licence No for the possession and use of Rectified Spirit valid up to ]¹

4. I/We agree to abide by the terms and conditions of the licence which may be granted/renewed, and the provisions of the Bombay Prohibition Act, 1949, and the rules, regulations and orders made there under.

5. I/We have enclosed in quadruplicate the site and elevation plans of the manufactory premises, together with relevant records.

6. I/We enclose four signed copies of the process which I/We desire to adopt for the manufacture of each variety of country liquor.

7. I/We enclose a Chalan No dated evidencing payment of a sum of ²[Five hundred rupees (Rs. 500)]² for the application.

8. I/We hereby declare that no excise licence previously held by me/us has been, revoked or suspended or has failed to be renewed owing to breach of the Act, rules regulations, notifications or orders governing the grant of such licence.

9. I/We declare that to the best of my/our knowledge and belief the information furnished herein is true and complete.

Place..................................................

Dated

Signature/s of the applicant/s

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