(f) I have/have not been convicted on (dates) at/any time of an/ any offence punishable under section/any provisions of the Bombay Prohibition Act, 1949. There is a/is no prosecution under section/any provisions of the said Act pending against me in the/any Court in 1Maharashtra State1.
(g) The particulars given above are correct.
I, hereby undertake to abide by the conditions of the permit and the provisions of the Bombay Prohibition Act, 1949, and the rules, regulations and orders made there under.
Dated: Signature of the applicant.
The Collector of
District......____
Form of Receipt
| S.No |
Received from *
Name in full ♦
Address in full ♦
an application for Temporary Resident's permit. |
| Signature of the Officer receiving the application and date. |
The applicant is requested to present this receipt personally on
♦To be filled in by the applicant.
[Reverse of the application Form F. L./A-1]
(Not to be filled in by the applicant)
Action taken
Received the application.
Dated: |
Date of Registration |
| Called on |
Permit prepared on |
| Checked by |
| Permit ready for delivery |
| Received the permit No. on |
Signature of the applicant.
Seen
Filed
Signature of the permit-issuing authority.