1[FORM ‘D’]
(See rule 5)
Form
of application for a licence to sell mild liquor
1. Name
and address of the applicant...
2. Names
and addresses in full of the
Partners, if any.
3. Name of the Hotel/Restaurant/Club/
Canteen and its address in full i.e. its
Exact location.
2[4.Whether the hotel,
restaurant or canteen is within a distance of seventy five meters form any educational
or religious institution or from any bus stand, stat in or depot of the Mahaarashatra
State Road Transport Corporation.]
1.
Whether the applicant holds at present or held at any time in the past any licence
for the sale or foreign liquor including mild liquor, ad if so, the period during
which it was held.
2.
Average number of residents/boarders/members or visitors, as the case may be, during
the last one year immediately before the date of the application.
3[7. (a) The details of amenities provided at
the hotel /restaurant/canteen club ad in the case of a club the objects and activities
thereof,]
(b)
4 *
5[© Carpet area
of hotel/ restaurant/ canteen
Where consumption of mild liquor will
be allowed and how many persons are/can be provided with sitting accommodation
at a time,
(d) What is the carpet area of the hotel/restaurant/canteen
excluding kitchen, cloak room, etc... which is not used for customers?
(e) Whether the establishment has a separate
kitchen and attached cloak room, providing wash- basin and urinal facilities;
(f) Whether the establishment has provision
for serving snacks, eatable etc.;
(g) Whether the establishment has separate store
room adjacent to the proposed licensed premises for storage of mild liquor.]
8. The grade,
if any, in which the hotel/restaurant/club /canteen is classified and the authority
for such classification, if any.
8A. 1 *
* * *
*
8. Proof of solvency of the applicant.
9. 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 therefore.
10. Whether the applicant is in Excise
arrears or I arrears of any other Government dues, such as Sales Tax, Income Tax.
etc.
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 form
time to time.
Date:
Signature
of the applicant
To
The Collector of ……………………………………]