प्रशासन व आस्थापना

7971949 : Bom. XXV] Bombay Prohibition Act, 1949 [FORM F. L. / A-10] [See rule 42-A (1)] Application Form for licence to sell beer [or wine or both] in sealed bottles. 1.Name and address of the applicant. 2.Names and addresses in full of the Partners, if any. 3.Name of the shop establishment and address in full with its exact location (if any). 4.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, and if so, the details thereof. 5.Whether the establishment has separate store room adjacent to the proposed licenced premises for storage of beer

[or wine or both.] 6.Details of Earnest Money Deposit deposited equi- valent to annual licence fee of one year (Pay Order/D.D.), Name of the Bank and date. 7.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 reasons therefor. 8.Whether the applicant is in excise arrears or in arrears of any other Government dues such as dues under the Land Revenue Code, Sales Tax, Income Tax, etc. 9.Proof of solvency of the applicant. 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. Signature of the applicant Date : To, The Collector of ........................................... 1Inserted by 19-8-2004. 2Sub. by 14-8-2006.