[FORM E LJA-6-A]

[See rule 70A(1)]

Application No.

Application for a tourist's permit to possess, consume, use and buy foreign liquor for personal consumption

Name in full (Surname first in BLOCK letters.)
Permanent address ..
Temporary address in the ²State of Maharashtra².

Period of temporary stay in―

(1) ²State of Maharashtra². The ¹
(2) India...
1. (a) Whether the applicant is a citizen of India.
2. (b) Name of the country where the applicant―
  1. (i) Was born
  2. (ii) Was brought up
  3. (c) Name of the country in which the applicant is domiciled.
  4. Number and date of passport, and Tourist Introduction Card or Tourist's visa and the authority which issued it.
  5. Age
  6. Number of units of foreign liquor per week.

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