FORM EL.W/A-1

(See rule 25B)

Form of application for a vendor's licence for sale of wines

Name, age and addresses of the applicant.
Names, ages and addresses in full of the partners, if the applicant is a partnership firm (copy of the Deed to be appended).
Exact location and full address of the premises where the business will be conducted.

Whether the proposed premises referred to at item 3 above are:—

(a) Within 50 meters from any educational or religious institution if they are within the jurisdiction of any Municipal Corporation or 'A' Class or 'B' Class Municipal Council and 100 meters if situated elsewhere, and.
(b) Within 50 meters from any busstand, station or depot of the Maharashtra State Road Transport Corporation.

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

I/We hereby enclose a Chalan No ________ dated ________ evidencing payment of a sum of Rupees ________ (Rupees ________ ) for the application.

I/We hereby undertake to abide by the conditions of the licence and the provisions of Bombay Prohibition Act, 1949, and rules, regulation and orders made there under from time to time.

I/We hereby further undertake to surrender the licence and agree to its cancellation, if considered necessary by the Government if it found at a subsequent stage that information furnished by me / us is false.

Dated ________

Signed before me

Notaries/ Special Executive Magistrate / Tahsildar. Signature of the applicant.

The Collector,
........... District.

¹[Ins. by G. N. of 28-12-2001]¹ ²[Deleted by G N. of 14-8-2006]²

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