अमरावती

[FORM ‘F’] [(See rule 6 (1)] Application for a licence to manufacture and sell liquor chocolates The Secretary to Government, Home Department, Sachivalays, Bombay. Through the Commissioner of Prohibition and Excise, Maharashtra State Bombay. (1) Name and full address of the applicant. (2) Names and addresses in full of the partners, if any. (3) Name of the confectionery and its address in full i.e. its exact location. (4) Monthly requirements of Indian Made Foreign Liquor required to manufacture and sell liquor chocolates (in terms of quarters of 750 ml.) (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 and if so, the period during which it was held. (6) Details of the total accommodation of the room where foreign liquor will be stored for the manufacture of liquor chocolates.

(7) Proof of solvency of the applicant. (8) Whether the applicant holds a licence from Food and Drug Administration Department, if such licence is necessary, for the manufacture of chocolates and if so its number and the period of validity. (9) Whether any Excise/Police/Municipal/ Drugs Prevention of Food Adulteration 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. 1 Added by G. N. of 8-4-1974.

1949 : Bom. XXV] Bombay Prohibition Act, 1949

(10) Whether the applicant is in Excise arrears or in arrears of any other Government dues such as Sales Tax, Income Tax. I, hereby declare that the particulars given above are correct. I, hereby undertake to abide by the conditions of the licence and provisions of the Bombay Prohibition Act, 1949, and the rules, regulations and orders made thereunder, from time to time.

Date : Signature of the applicant.