(iii) Whether the applicant was holding or was granted a licence in Form CL. III for the retail sale of country liquor but was not operating it on 1st January, 1979 and if so, reason (s) therefor.
I/We hereby declare that the particulars given above are correct.
N. B. : Wilful submission of false information or mis-representation of facts will render the licence, if eventually granted liable for cancellation under section 54 (1) of the Bombay Prohibition Act, 1949.
I /We enclose a chalan No date evidencing payment of a sum of Rupees (Rupees .) for the application.
I hereby undertake to abide by the conditions of the licence and the provisions of the Bombay Prohibition Act, 1949, and the rules, regulations and orders made there under from time to time.
Date .......... ..... Signature of the applicant
Signed before me
Notary/Special Executive Magistrate/Tahsildar.
* The Secretary to the Government of Maharashtra. Home Department, Mantralaya, Bombay 400 032. (Through the Collector of )
† The Collector of
♦ when application is for grant of a licence.
† when application is for renewal of a licence.
FORM CL. III
1See rule 24(1A)]
Licence No
Licence for the retail sale of country liquor
Licence is hereby granted, to Shri /Messrs (herein after called "the licensee") authorising him to sell country liquor by retail at his shop situated at more particularly described in the Schedule hereto (herein after referred to as "the shop") for the period commencing on and ending on 31st 20 , under and subject to the provisions of the Bombay Prohibition Act, 1949 and the Maharashtra Country Liquor Rules, 1973 and other rules, regulations and orders made under the Act in so far as they relate to the retail sale of country liquor and the following conditions, namely
1[Subs. by G. N. of 26-2-1982]