Form of Application for a Licence to Sell Country Liquor by Retail

1[FORM C.L.A.I.]

(See rules 23 and 29)

Form of application for a licence to sell Country Liquor by Retail

1. Name, age and address of the applicant

2. Names , ages and address in full of the partners,

If the applicant is partnership form (copy of the

deed to be appended.).

3. The address I full of the premises where the

Country Liquor would be sold.

4. Whether the proposed remises referred to

at item 3 above are-

(a) within 50 meters form any educational or

religious institution, if they are within the

Jurisdiction of any Municipal Corporation

or ‘A’ Class or ‘B’ Class Municipal

Council adn100 meters if situated elsewhere.

(b) Within 100 meters form any bus stand, station or depot of the Maharashtra State Road Transport Corporation :

5. (a) Whether the applicant or any member of his family (or any of the partners) holds at present or held at any time in the past (individually or in partnership with any other person) any excise licence(s) and if so, indicate the particulars of such licence(s) held and also the period(s) for which he held.

Explanation- For the purpose of this clause ‘family’ means a person and his spouse (or more than once spouse) and his children solely dependent on him for their maintenance.

(b) Whether the applicant is holding a Vendor’s licence for sale of Foreign Liquor and if so, whether he desire to sell country liquor in scaled bottles at the same licensed premises.

6. Whether the applicant holds the solvency certificate or bank guarantee. If so, give particulars with copy thereof duly certified by Notaries, Special Executive Magistrate or Tahsildar.

7. Present occupation and income therefrom.

8. Whether the Food and Drug licence in any held by the applicant is or was suspended or cancelled at any time in the past, and if so , the period of such suspension or cancellation and the reasons therefore.

9. Whether the applicant is in arrears is in arrears of excise or any other Government dues.

10. Whether the applicant has experience of conducing liquor trade and if so, state details with documentary evidence support.

11. Whether the applicant belongs to any of the following categories and if so, to produce proof in support:-

(i) Whether the applicant belongs to Economically Weaker Section,

(ii) Whether the applicant has in his possession ready premises for the proposed shop and if so, details thereof.

(iii) Whether the applicant was holding or was grated a licensed I Form C.L. III for the retail sale of country liquor but was not operating I on 1st January, 1979 and if so, reasons(s) therefore.

I/ We hereby declare that the particulars given above are correct.

N. B. : Willful submission of false information or mis-representation of facts will render the licence, if eventually grated liable for cancellation under section 54 (l) (e) of the Bombay Prohibition Act,1949.

I/ We enclose a chalan No. …………………. Date ……………………………. Evidencing payment of a sum of Rupees …………………… (Rupees………………..)

For the application.

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 form time to time .

Date …………… Signature of the applicant.

Signed before me

……………………………….

Notary/ Special Executive Magistrate/ Tahsildar.

To,

The Collector of………………….)