FORM EL./A-3
[See rule 67(1)]
Application No.
Application for a permit to possess foreign Liquor for medicinal use on emergent occasions
- Name in full Shri/Smty Kumari .. (Surname first in BLOCK letters)
- Residential address in full ..
- Nationality ..
[See rule 67(1)]
Application No.
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.
Signature of the Applicant.
Dated:
The Collector of ........... ............ ............ ............ District
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