FORM F. L. XII

Licence is hereby granted under and subject to the provisions of the Bombay Prohibition Act, 1949 (Bom. XXV of 1949), and the rules, regulations and orders made there under to of (herein after referred to as "the licensee") on payment of a licence fee of Rs authorising him to sale ¹[champagne, port-type wine, port-wine, wincamis, vibrona, manola, and buck fast tonic wine]¹ on prescription at his premises situated at (herein after referred to as "licensed premises") during the period from to on the following conditions, namely;

Conditions

1. The licensee shall not keep or sale ²[Champagne and Port Wine]² at any place other than the licensed premises.
2. The licensee, his heirs, legal representatives or assignees shall have no claim whatsoever to the continuance or renewal of this licence after the expiry of the period for which it is granted. It shall be entirely within the discretion of the Collector to permit or not the assignee of the licensee in case of sale or transfer or the heir or legal representative of the licensee, in case of death, to have the benefit of the licence for the unexpired portion of the term for which it is granted.
3. This licence may be suspended or cancelled in accordance with the provisions of section 54 or 56 of the Bombay Prohibition Act.
4. In case this licence is suspended or cancelled during the currency of the licence period or is not renewed on its expiry the licensee shall forthwith surrender to the Collector the whole stock of unsold ¹[champagne, port-type wine, port-wine, wincamis, vibrona, manola and buckfast tonic wine]¹ remaining in balance with him on the date of such suspension, cancellation or expiration. The stock of liquor so surrendered shall be sold by the Collector and the proceeds of the sale shall after deducting the expenses and any sum due to the State Government be returned to the licensee.

Place:

Date: Collector of

Seal of the Collector