FORM KL/A-6-B1

³[I hereby declare that I require foreign liquor and country liquor on grounds of health and in support of my application. I submit herewith the medical certificate in Form FJL/M.C. I signed by Dr _________________ Registered Medical Practitioner.]³

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.

Place: Signature or thumb impression of
Date: the Applicant.

The Collector of __________________________ (or authorised Officer.)

⁴[FORM EL.X-B]⁴

(Deleted)

⁵[FORM ELJ.A-6-C]⁵

(See rule 70-F)

Court Fee Stamp Application No.

Application for a permit for the purchase, possession, transport, use and consumption of mild liquor in the State of Maharashtra.

1. Name in full Shri/Smt/Kumari (Surname first in block letters)
2. Residential address in full