FORM E4

FORM E4

(See rule 5A)

Form of application for a licence to sell wine.

1. Name and address of the applicant.
2. Names and addresses in full of the partners, if any.
3. The address in full of the premises where wine would be sold.
4. ¹[Whether the proposed premises referred to at item 3 above are—
   1. (a) within 50 meters from any educational or religious institution, if they are within the jurisdiction of any Municipal Corporation or 'A' Class or 'B' Class Municipal Council and 100 metres if situated elsewhere.
   2. (b) within 100 metres from any bus stand, station or depot of the Maharashtra State Road Transport Corporation.¹]
5. Whether the applicant holds at present or held at any time in the past any licence for the sale of foreign liquor including mild liquor or wine and if so, the period during which it was held.
6. ¹[Carpet area of the proposed licence where consumption of wine will be allowed and sitting capacity provided at a time.¹]
7. ¹[Whether the establishment has separate store room within proposed licensed premises for storage of wine and its area.¹]
8. ¹[Total area of the proposed licensed premises.¹]
9. Proof of solvency of the applicant.
10. Whether any Excise/Police/Municipal Licence held by the applicant was suspended or cancelled at any time in the past, and if so, the period of such suspension or cancellation and the reason therefor.
11. Whether the applicant is in Excise arrears or in arrears of any other Government dues, such as Sales Tax, Income Tax, etc.

I, hereby declare that the particulars given above are correct.

I, Hereby undertake to abide by the conditions of the licence and the provisions of the Bombay Prohibition Act, 1949, and the rules, regulations and orders made thereunder from time to time.

Date: _________________ Signature of the applicant.

The Collector of_______________

¹ Ins. by G.N. of 8-1-2002.

² Sub. by 27-7-2007.