FORM ELX-D

FORM ELX-D

(See rule 70-F)

Shri/Smt./Kum __________ age __________ residing at __________ is hereby permitted to purchase, possess, transport, use and consume mild liquor within the State of Maharashtra, subject to the provisions of the Bombay Prohibition Act, 1949, and the rules, regulations and orders made hereunder, during the period commencing on the date on which this permit is granted and ending on __________

Place: __________

Date: __________ Signature of Officer.

Seal

Specimen signature or thumb impression of the permit holder.

(To be filled in and handed over to the Officer issuing permit for grant of permit for subsequent period.)

I declare that I continue to require mild liquor for preservation and maintenance of my health.

Place: __________

Date: __________ Signature of thumb impression of permit-holder.

1 Ins. by G. N. of 8-8-1979.