Application form for sale of Beer Wine in Sealed Bottle Name and address of the 1 applicant Name and address of the partner 2 if any Proposed premises name and 3 complete address Whether the applicant hold license for the sale of Mild liquor 4 or IMFL, if yes details Whether the applicant hold 5 separate godwon for storage of liquor Whether Security deposit of 6 equals to 100% of licence fee is deposited Whether licence was cancelled or suspended by Police dept, State 7 Excise or corporation, if yes, give detail Whether application is defaulter of Land & revenue , Sale Tax, 8 Income Tax or any goverment Dept Proof regarding solvency 9 certificate
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 ----------------------------------- 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 ----------------------------------- 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