[FORM F. L. M. C.-2] (See rule 70-F) (For applicants in Wardha District only) Application Form F. L./A. 6-C No. ........................................ Certificate of Registered Medical Practitioner recommending the grant of permit to possess and use mild 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 mild 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 : Station Signature of the Registered Medical Practitioner and his name and Date : Registration No.