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[(See rule 70-D)] Application Form F. L./A-6D No. ............................................................................................... Certificate of a Registered Medical Practitioner/Government Medical Officer recommending the grant of permit to possess and use foreign liquor and country liquor for personal consumption. This is to certify that Shri/Smt./Kum. ................................................................................ of ...................................................... by his/her statement aged ..................................................... years and is apparently about ............................................. years of age and that he/she requires foreign liquor and/or country liquor for the preservation and maintenance of his/her health.The grant of the permit to him/her is recommended. Signature or thumb impression of the applicant ......................................... Full address of the applicant : Signature of the Registered Medical Practitioner and his name and Station registration number. Date : Signature and Designation of a Govern- ment Medical Officer and his name.] 1.Ins. by G. N. of 8-8-1979. 2.Subs. by G. N. of 4-5-1982.