FORM C.L. XIX

[See condition 12, 4, 7(ii) and 4(H) of the licences in Form C.L. I, C.L. II, C.L. III and C.L./F.L./III respectively]

Form of Register of Nokars/Agents to be maintained by the Licensee

Serial No.	Name, address and age of the Nokar/Agent in whose name the Nokarnama is issued	Monthly wages including all allowance paid to the Nokar/Agent	Date of issue of Nokarnama	Chalan No. and date of payment of fee	Place at and purpose for which the Nokar/Agent is appointed	Remarks, if any
(1)	(2)	(3)	(4)	(5)	(6)	(7)

FORM C.L. XX

[See conditions 17, 11, 15 and 8th of licences in Form C.L. I, C.L. II, C.L. III and C.L./F.L./III respectively]

Form of Undertaking

I/We hereby undertake to abide by the conditions of the licence in Form C.L. I/C.L. II/C.L. III/C.L./F.L./III that may be granted*/renewed* in my/our favour; and the provisions of the Bombay Prohibition Act, 1949 and the Maharashtra Country Liquor Rules, 1973 and other relevant rules, regulations and orders made there under from time to time.

Date

Signature of the Applicant.*

*The Director of Prohibition and Excise, Maharashtra State, Bombay.

♦The Collector of

- Strikeout whichever is not applicable.

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