FORM E L./A-4

1 Added by G.N. of 18-9-1961
(d) a member or the staff appointed by or serving under any person specified in clause (a), (b) or (c) and whether such member is national of a Foreign State or an Indian national; [Please state the official designation of the applicant and the name of the Foreign State, in each case, i.e. (a), (b), (c) or (d),] or

²[(d₁) a member of a Foreign Government; or]²

1 Added by G.N. of 18-9-1961
²[(d₂) a representative or officer of an international organisation to which privileges and immunities are given from time to time by or under the United Nations (Privileges and Immunities) Act, 1947; or]²

1 Added by G.N. of 18-9-1961
(e) the consort of any person specified in clause (a), (b), (c), ²[(d), (d₁) or (d₂)]² (please state the name and official designation of such person); or

1 Added by G.N. of 18-9-1961
(f) any relation of any person specified in clause (a), (b), (c), ²[(d) or (d₁)]² dependent upon him; and if so, what is the relationship and with whom (please state the name and official designation of such person).

Nationality ..

Religion ..

Age

Permanent address ..

Maximum number of units of foreign liquor desired to be possesses at a time.

Period for which the permit is required.

I hereby undertake to abide by the conditions of the permit and the provision of the Bombay Prohibition Act, 1949, and the rules, regulation and orders made there under.

Signature of the applicant and
Dated: his designation.

* Please strike off the unrequired items or words.

1. Added by G.N. of 18-9-1961.

2. Subs. ibid.