FORM E L.A-IE

[See rule 48A]

Form of application for registration of premises to obtain a temporary licence for a special function or event.

Name of the premises.
Name of the Owner/Lessee (Legal Occupier) of the Premises.
Whether the applicant is a resident of India or not.

Address and details of the applicant.

Exact Location and address of the premises.

Whether the premises holds on the date of this application or held at any time in the past any licence for the sale of foreign liquor and if so, the period during which it was held.

Area of the entire premises in square meters.

Area of the proposed premises with exact location where the applicant desires to sale/serve liquor in square meters.

If the premises is situated in Gram Panchayat area then,

(a) if the population is more than 20,000 then whether it is within the distance of 500 meters; or
(b) if the population less than 20,000 then whether it is within a distance of 220 meters, from the edge of the National or State Highway or the edge of the service road adjacent to such highway.
Whether any excise/police/municipal licence held by the applicant is or was suspended or cancelled at anytime in the past, and if so, the period of suspension and, the reasons for such suspension.

I hereby declare that the particulars given above are correct.

I hereby undertake to abide by the conditions of the licence and the provisions of the Maharashtra Prohibition Act [Bom. XXV of 1949] and the rules, regulations and orders made there under from time to time.

Signature of the Applicant.

Date:

The Superintendent, State Excise of ...................

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