FORM C.I.XVII

Appointment from the period mentioned in the ______ 20 to the ______ 20 . for me/us in respect of the following functions that is to say namely :

1. (a) to officiate for me/us at our wholesale shop at _______________________________ and
2. (b) to transport country liquor.

2.

The said person is competent in my/our absence to conduct my/our abovementioned duties in accordance with the provisions of the said rules. He is of a good character; and as far as I/We know, he has not been convicted of any offence under the Bombay Prohibition Act, 1949, nor has been convicted by Criminal Court or Black listed in respect of excise licence, rendering him unfit for appointment as Nokar.

3.

I/We have explained to him personally all the conditions of my/our licence and I/We hold myself/ourselves responsible personally for any offence he may commit in the conduct of the business under my/our licence.

4.

The Nokarnama shall become invalid if it is issued to person below 21 years of age and on the suspensions, cancellation or expiry of my/our licence or if a competent officer revises countersignatures thereon. This Nokarnama will also become invalid, if the Superintendent concerned issues order to that effect. This Nokarnama shall be kept with the employees.

Dated ______ 20 .

Signature of the licensee.

The sum of Re. 1 only as the fee prescribed for the issue of this Nokarnama has been paid v/d chalan No ______ . ______ dated ______ . ________

Dated ______ 20 .

Signature of the licensee.

1. The appointment of the abovenamed Nokar is noted.
2. The Nokarnama shall be in operation till the ______ . ______ . ______ 20 but it is liable to cancellation for any breach, on the part of the nominee, of the Bombay Prohibition Act, 1949 or for any other offence rendering him unfit to hold the appointment hereby made.

Dated __________ 20 .

Signature and Designation of Prohibition and Excise Officer.

Y-373-75