FORM FL-A-10
(See Rule 42 A (1))
Application form for
sale of Beer Wine in Sealed Bottle
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1
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Name and address of the applicant
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___________________________________
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2
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Name and address of the partner if any
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___________________________________ |
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3
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Proposed premises name and complete address
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___________________________________
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4
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Whether the applicant hold license for the sale of Mild
liquor or IMFL,
if yes details
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___________________________________
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5
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Whether the applicant hold separate godwon for storage of
liquor
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___________________________________
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6
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Whether Security deposit of
equals to 100% of licence fee is
deposited
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___________________________________
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7
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Whether licence was cancelled or suspended by Police dept,
State
Excise or corporation, if yes, give
detail
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___________________________________
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8
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Whether application is defaulter of Land & revenue ,
Sale Tax, Income Tax or any goverment Dept
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___________________________________
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9
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Proof regarding solvency certificate
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___________________________________
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Signature of applicant
Date
Place
To,
The Collector
(State Excise Deparmtent
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List of document required for Grant of FLBR-II Licence
1. Application in prescribed format
2. Application Fee vide challan of Rs. 100/-
3. (3) copies (Blue print) map of proposed Licensed premises.
4. Certificate of legality
of structure from concerned department
5. No dues with Sales Tax / Income Tax department Affidavit
6. Leave License copy of proposed licence premises
7. Affidavits regarding No Excise Schedule Licence in the
name of
proposed licensee
8. Rent receipt of premises from concerned department
9. Shop & Establishment licence
10. Concerned department Tax receipt
11. NOC of Land lords / Society to sell beer in the premises
12. Bank Guarantee 100% of licence fee
13. Proposed premises should be minimum 180 Sq.Foot
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Action taken by the Excise Department
14. Police Verification / character certificate
15. Department Inspectors / Sub Inspectors Report
16. Applicant statement record in presence of Officer of
State Excise
17. concerned department report regarding legality of structure / No
action pending against the proposed premises
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After approval by the committee under the chairmanship of
Collector
18. 25% of the licence for FL-3 i.e Licence
fee for FLBR-II,
19. Security Deposit of Rs 10,000/-
20. Applicants 3 Passport size Photos