17. The kind of permit the applicant has applied or is applying for, that to say, whether a health permit, temporary resident's permit or special permit fbr privileged personages.
18. Period fbr which the interim permit is required.
I hereby declare that—
- ♦ (a) (I) I require foreign liquor for the preservation or/and maintenance of my health.
- ♦ (II) 1 am a temporary resident;
- ♦ (III) I am eligible for a permit under section 41 of the Act;
- ♦ (b) I am ordinarily using and consuming foreign liquor;
- ♦ (c) Foreign liquor is being generally used or consumed in the country where I was bom and brought up or domiciled;
- (d) I do not hold any permit under section 40,40-A, 41, 46, or 47 nor have I made any other application for an interim permit;
- (e) 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.
Signature of the applicant.
Date:
The Collector
The Prohibition and Excise/Police/Customs Officer-in-charge.
♦strike off clauses which are not applicable.
[Reverse of Form E LJA-6]
(For office use only)
Date of application:
Registration No.:
Permit prepared by ............................................... and issued on
Received the pennit No .
Signature of the applicant.
Forwarded to the Superintedent of prohibition and Excise, for disposal.
Prohibition and Excise
Police Officer-in-charge.
Customs.
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