FORM F.L./A.S.P.O.

[Sec rule 25AB(1)]

Form of application for upgradation of Primary licence in Form FL-II /see rule 25(1)] to Super Premium outlet in form FL.III/S.R.O. by way of extension of area adjacent in continuation to the approved premises or by shifting of licence to the suitable premises.

Name, age and address of the applicant licensee.
Names, age and addresses in full of the partners, if the applicant is a partnership firm (copy of the Deed to be appended).
1. (a) Exact location and full address of the current premises of the applicant's valid licence in Form F.L. II.
2. (b) Exact location and full address of the Proposed premises.
3. (c) If applicant is requesting for upgradation by way of extension of area adjacent and in continuation to the approved premises of the licence ? or

(d) If applicant is requesting for upgradation by way of shifting its licence in Form F.L. II under rule 25 AB(1)?

(e) Carpet Area of the Proposed premises (in Sq. Meter) (Area shall not be less than 601 Sq. Meter).

(f) Is construction of Proposed premises is authorised? (Attach valid Proof).

(g) Whether any excise licence held by applicant was cancelled anytime in the past, and if so, the reasons for such cancellation.

(h) Whether applicant is in arrears of excise or any other Government dues.

Whether the proposed premises referred to at item 3 above are,-

(a) Within 50 meters from any educational or religious institution or statue of National Personality if they are within the jurisdiction of any Municipal Corporation or 'A' Class or 'B' Class Municipal Council and 100 meters if situated elsewhere,
(b) Within 50 meters from any Bus stand, station, or depot of the Maharashtra State Road Transport Corporation.
(c) Free from highway restriction as per rules or time-to-time orders/ instruction from the State Government.
(d) If the nearest distance between the proposed premises from another similarly upgraded F.L.II licence under this rule is less than 1000 Meter.

I/We hereby declare that the particulars given above are correct.

I/We hereby enclose a chalan No dated evidencing payment of sum of Rupees /- (Rupees in words) for the application.

I/We hereby undertake to abide by the conditions of the primary licence in Form F.L.II and the form of its upgradation and the provisions of Maharashtra Prohibition Act, and rules, regulation and orders made there under from time to time.

I/ We hereby further undertake to surrender the primary licence in form F.L.II along with the form of upgradation provided under sub-rule (4) of rule 25AB and agree to its cancellation, if considered necessary by the Government or granting authority if it found at a subsequent stage that information furnished by me/us is false.

Dated Signature of the applicant.

Signed before me

Notaries/ Special Executive Signature of the Magistrate /Tahsildar.

The Collector, District.]

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