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~ 3-1 I cil cfi 1-il 3Wclcfi"RT / ~ ~ .~&RT ~ ~ ~ ~ GOVERNMENT OF CHHATTISGARH FINANCE, COMMERCIAL TAX, PLANNING, ECONOMIC AND STATISTICS DEPARTMENT MANTRALAYA, RAIPUR Raipur the 23rd May 200 I NOTIFTC 1-\TION No. F 10-49/2001 /CT/V ( 15)- In exe rcise of t he powers conferred by sub section (I) of section 18 read with c lause (d) (e) (f) (g) (h) of sub section (2) of secti on 62, of Chhatt isgarh Excise Act ,- 1915 208 (8) {fo·t"i ~-1JI<$ ~ . fcRtfi 23 rrt 2001 (No, 11 of 1915) , the State Government makes the fo llowing rules for the settlement of foreign liquor shops in the revenue dist ricts Raipur, Durg, Raj nandgaon, Dhamtar i and Mahasamund wh ich were published previously as re qu ired by sub section (3) of section 62 , · in Chhattisgarh Gazette .
1. Short title and conmmencement-
2.
(i) . These rules may be called the "Chhattisgarh Excise Settlement of Licences fo r retail sale of foreign liquor (in district Raipur, · Durg, Rajnandgaon , Dhamtari and Mahasamund) Rules 2001."
(i1) These shall come .into force from the date of th ei r publication in th e Gazette.
Definitions- In these rules, unless there is anything rep ugnant in . the subject or context-
(a) "Act" means the Chhattisgarh Excise Act , 1915 (No. II of 1915); as· amended fr.om .time to time .
(b) "Foreign Liqu or" means and includes spirit or liquors imported into India or sprit or liquors made in India and soph isticated or coloured so as to resemble in flavour or colour liquor imported into India and includes Malt Sprit, Whisky, Rum, Brandy, Gin , Vodka and Liqueur.
(c) "Excise year" means the financial year commencing from 1st April to 31st March of th e calender year :
(d) "Family" means and includes spouse (husband or wife) , son (s) , unmarried daughter (s) and dependent parents .
(e) "Form" means the form appended to these rules .
(f) "Licensing authority" means the Collector of the District ,
(g) "Licence fee" means a sum fixed in consideration of the grant of the licence for exclusive privilege for seling of fore ign liquor in a retail shop under clause (ii) of subsection 2 of section 62 of the Act as fixed by the State Government from time to time for the whole excise year or part thereof which shall be fixed on the basis of its location in the areas of Mtinicipal Corporat ion, Municipal Committee, N·agar Panchayat & Rural area.
(h) "Min imum month wise guarantee.d quan itity", means the quantity of foreign liquor as fixed by the licensing authority in accordance with the general or specific instructions issued by the Excise Commissioner and guaranteed by the licensee to be lifted by him for his retail shop in a month of an excise year for the purpose of retail sale which shall be fixed for any foreign liquor shop on the basis of maximum lifting in a district during last five years after making necessary increase/decrease .
(i) "Annual Quantity" means the sum total of the month wise guaranteed quanity of an excise year ;
(j) "Security amount" means a · sum equal to 1/12 the part of total payable duty calculated at the rate of Rs. 150/- per/proof litre of spirit and Rs. 10/- per bottle of Beer to be deposited in cash in Government Treasury as interest free security, refundable after the final settlement of all the claims and dues_ to the state Government .
3. Settlement of Licences for retail salea. Subject to the provision of these rules and subject to the payment of licence fee and security amount , the retail shop for sale of foreign liquor shall be settled or resettled by fixed fee system as specified herein .
b. The licence shall be granted in th e From F. LI -D for reta il sale of foregin liqour in_ sealed bottles.
4. Power to fix the number and location ·of retail shops- Number of shops shall be fixed by the licensing authority under genera l or specific instruct ions issued by the state government or by the Excise Commissioner from time to time. Location of shop shall be as per the provisions of rule (1) of rules of general appl ication framed under the Act .
5. Period of Licence- The period of licence shall be for an excise year or part thereof for which the licence has befm granted. The licence may be renewed on such terms and conditions as may be dec ided by the State Government .
6. Payment of Licence fee & Security Amount- The licence shall be granted on payment of licence fee, and depos it of the security amount.
7. Application for grant of licence-
(a) Whenever a new licence is proposed to be granted in an area or locality, the licensing authority shall invite the applications for this purpose after giving wide publicity through daily newspapers having circulation in that area.
(b) A list of the retail shops of foreign liquor for which the Collector proposes to grant licence, shall be exh ibited along which shopwise licence fee and secur ity amount at the Collector's office, Tehsil 0.1fice and the office of the District Excise Officer/ Asstt . Commissioner Excise of
8.
fulfil
(c)
9.
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11.
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(d) n wi· Eligibi followini
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(b) BE
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(4) Tt of d lie
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Select a. Tl re b. Tl ai to ar fc st C. In a d. Li w Stater of the licens Officer/ Asst! .
e ity ee es.
the :ise Jles hich · be ance 1ority apers ence, ictor's ise of 208 ( 9) the district .
(c) Application for grant of licence shall be made in the prescribed form as appended to these rules.
(d) The last date to be f ixed for the receipt of application shall not be earlier than seven days with effect from the date of publicati on of the advertisement in a newspaper .
s. Eligibility Conditions for appl icants- · Eligible applicants for licence of a retail foreign liquor must fulfil following condition namely-
(c)
(a) Be a c it izen of India or A partnership firm whose partners are citizens of India. No change in partnership shall be allowed after the sett lement of shops.
(b) Be above 21 years of age .
(c) Not be a defaulter/blacklisted or debarred from holding an excise licence under the provisions of any rules made under the Act.
(d) Submits an affidavit duly verified by pub lic notary as proof of the following namely-
(1) That the possesses or has an arrangement for taking on rent a suitable premise in that locality for opening the shop in accordance with the rules;
(2) That his proposed prem ise of the shop have not been constructed in violation of any law or ru les; ,
(3) That he posses good moral character and have no criminal background and have not been convicted of any offence punishable under the Act or Narcotic Drugs And Psychotropic Substances Act. 1985 or any other law for the time being in force, or any other cognizable and non-bailable offence;
(4) That in case he is se lected as licensee he will furnish a cert if icate issued by Superintendent of Police of the district of which he is t he resident, showing that he po·ssess -good moral character and have no crim inal backgrou nd or criminal record, within thirty days of grant of licence ;
5. That he shall not employ any, salesman or representative who has criminal background as mentioned in clause ( Il l) or who suffer from any infectious or contagious disease or is below 21 years of age or a woman;
6. That he is not in arrear of _any Government dues .
Furnish a bank draft drawn in favour of the District Excise Officer or Asstt . Commissioner issued from a nationalised Bank as earnest money. The amount of earnest money shall be as fixed by the Excise Commissioner. In ca.se the applicant is selected as licensee, the earnest money shall be adju.ted against the licence fee . In other cases it shall be returned as such to the app licant as soon as the select ion process is over.
9. District level committee- The re shall be a district level committee fqr selection of licensees for 10, retai l sale of foreign liquor. The committee sha ll consists of the-
(i) The Collector of the Distr ict
(ii) One Gazetted Office of Exc ise Department nominated by the Exc ise Commissioner
(iii) The District Excise Off icer/ Asst!. Excise Commissioner _of the District Selection of Licensee- Chairman Member Member/ Secretary a. The District Excise Officer/ Asst!. Excise Commissioner shall prepare a list of all applications received with summary report to be put before the district level committee for licencing .
b. The said committee shall select licensees from the list of applicants . In case more than one applicant are found suitable for any part icu lar shop, the comm ittee shall select the licensee for such shop by public lottery. In case the selected applicant 'does not deposit t he required amount and does not fulfil the prescribed formalities or is unable to arrange suitable premises for the shop with in stipulated period , the licensing authority shall cancel the allotmentand tal<,e steps for resettlement of the shop.
c. In case there is no application for a particular shop or no cand idate is found suitable for a shop , the licensing authority shal l take immediate steps for resett lement of the shop .
d. Licensing authority shall have the right to reject applications received for a shop or shops without assigning any reasons.
11, Statement of Settled shops- As statement of the sett led shops alongwith names and adresses of the licensees, details of security amount and · licence-fee deposited shall be sent by the District Excise Officer/ Asstt. Commissioner Excise to the Exc ise Commiss ioner within 15 days of the settlement 208 ( !O J
12. Payment of Licence-fee and security amount- In case an app licant is selected as licensee, he sl:ian deposit the entire amount of lice nse fee and th e security amount within 3 days of being informed of his selection. If he fails to deposit the amount of licence fee and security amount within presc ribed period, his selection shall stand cancelled and his earnest money shall be forfeited in favour of the state Government and the said licencsee sh all be debarred from holding any excise licence .in future anywhere in the stae . A consolidated list of such defau lters under this rule, along with their complete address sha ll be forwarded by the District Exice off icer/Asst! . Commissioner to the Excise Commissioner, who will circu late the_ consol idated list ot' ·the state to all licensing Authorities the state .
13. Lifting of liquora. The licensee under these rules shall obtain supplies of fore ign liquor from any wholsale licencee after making full payment of cost pr ice of fo reign liquor including all taxes, duties .
and cess as levied from time to time. The licensee shall place indent at-least 72 hours in advance to the wholesale licensee from whom he intends to procure the supply of foreign 'iquor. - b. rhe wholesale licensee/supplier with whom J.hl;! indent has been placed shall record the date and time of receipt of indent and shall ensure supply of the desired quantity of liquor within 48 hours of the receipt of indent.
14. Lifting of minimum Guaranteed Quantity fixed for the month and consequences of failure-
(a) The licensee is liable to lift the entire minimum monthwise guaranteed quantity during a month .
The licensee shall make indent for the entire minimum monthwise guaranteed quanity fixed for that month along with cost of foreign liquor including all duties taxes and cess, which must be submitted to wholesale licensee by 25th day of the month .
(b) In case the retail licensee fails to submit the indent as per clause (a) the. District Excise Officer/ Asstt. Commissioner- shall immediately report the matter to the licensing authority, who shall taken action to impose penalty on the amount of guaranteed quantity less lifted than the fixed monthly guaranteed quantity at the rate of rupees 150/- proo'f litre and shall adjust the amount equal to the . imposed penalty from the seecurity amount and issue a notice to the licensee to replenish th.e shortfall in security amount with in a week and also show cause as to why the licence should not cancelled. If the licensee fails to deposit the amount of deficit in security amount and does not furnish suitable explanantion whithin the stipulated period , the licence shall stand cancelled and th~ licensing authority shall take immediate steps to resettle the shop.
15. Lifting of foreign liquor in excess of minimum monthwise guaranteed quantity- The iicensee may lift in excess of monthwise minimum guaranteed ,quantity for the month with the permission of the District Excise Officer/Asstt. Commissioner and on payment of additional excise duty as may . be prescribed.
16. Minimum retail Price- The minimum retail price as may be fixed by Excise Commissioner on approval of the State Government, shall be printed on the label of bottles of foreign liquor.
The licensee shall not charge from consumers less than the minimum retail price as .may be fixed by the Excise Commissioner on approval of the State Government .
17. Hours of sale and closure of shops- The licenced primises shall remain open for sale on all days from 10.00 am to 10.30 p.m. except on 15th August (independance day) 2nd October (Gandhi Jayanti) , 26th January (Republic Day) Hali and Mohharum and upto 3 more days as notified for closure by the licensing Authority, Licensing authority may also order for closure of shop on account of law and order or General Election related activity under the provisions of relevant laws. No compensation shall be given for the closure of shop on above grounds.
18. Disposal of Balance stock left at the expiry of the Licence- Any balance of foreign liquor found outstanding and unsold at the expiry of the term -of liGence shall be declared by the licensee to the licensing authority on the next day and shall be returned by him to the concerned wholesale/supplier/shop(s) of the district by 5.00 pm of the next date of expiry of licence, the licensee shall be entitled to get the refund of cost price only, excluding duty and other taxes. The disposal of such stock shall be made as per orders of the Excise Commissioner in this regard.
19. Surrender of licence- A licensee may surrender his licence after giving atleast one. 1:onth's notice in writing to the licensing authority under provisions of section 33 of the Act. On receipt of such dues fro cornrnis:
delay fc
20. St (b (c (d (e
21. F comme1 F of fore Licence Locality.
Licence Annual Minimu SL. Ne
1.
2.
3.
4.
5.
6.
7.
8.
9.
10/ .11.
12.
r l l £kc11WI ~ ~. fcf.:Ttct;- 23 ~ 2001 208 ( 11 j of such application the licensing authority will take steps for recovering all outstanding excise dues from his security deposit and refund the balance amount after obtaining orders of the Excise Commissioner. The licensing authority shall also proceed for resettlement of the shop without delay for the remaining period of the excise year.
20. Suspension and cancellation of the licence and penalties- (I) Licensing authority may suspend or cancel the licence-
(a) If any bottle is found in the licensed premises on which duty has not been paid aild which does not carry security hologram duly approved by the Excise Commissioner as a proof of payment of duty :
(b) If any other kind of liquor or intoxicat ing drug (for which licence is not granted) is found in the licensed premises ;
(c) If the affidavit submitted by the licensee at the time of application is found incorrect and assertions made there in are · found to be false ;
(d) If the licensee is convicted . of any ·offence punishable under the Act or any other law for the t ime being in force relating to revenu e, or any .cogn izab le and non bailable offence, or any offence punishable under Narcotic Drugs and Psychotroic Substances Act, 1985 or of any offence punishable under sections 482 to 489 of the Indian Penal Code.
(e) If any bottle is sold below the min imum rate as prescribed by Excise Commissioner. under rule 16.
(f) . If the licensee fails to lift the minimum monthwise guaranteed quota and also fa ils to replenish the shortfall in security deposit within the period prescribed, cdnsequent to the imposit ion of penalty.
2. The licensing authority · shall immediately suspend the licence and forfeit the security deposit on above mentioned grounds. The licensing authority will also serve a show cause notice for cancellation of licence and the licensee shall submit his explanation with in 7 days of the receipt of the notice . Thereafter the licensing authority will pass suitable orders after giving due opportunity of hearing to the licensee, if he so desires.
3. The licensee shall not be entit led to claim any compensation or refun d for suspension or cancellation of licence under th e . rules .
4. In case the licence is cancelled on the above mentioned grounds the licensee may also be blacklisted and debarred from holding any excise licence in future.
21. Repeal and Saving- (i) A ll rul~s corresponding to these rules inforce immediate ly before the commencement of . these rules are hereby repealed irrespective of matters covered by these rules.
P~ovided that any o"rder made or action taken under the rules so repealed shall be valid in respect of foreign liquor shop/shops for the financial year 2001-2002 .
F.L. 1- D Rule 3 Licence for the retail sale of foreign liquor in sealed bottes for Licence No ........ : ...... ... ..... ... ... ... .. ....... .. .. .... ..... : ............. .
Locality ... .... ...... ... ........... ... ... .. : .. .. ...... ........................ ...... . District. .............. .................... .. .. ........ .
Licence fee Rs ......... ........ .. ... .. .. .............. (in figures) ........ ... ... ........... ............... .... (in words) Annual Quantity- Minimum monthwise guaranteed quantity.
SL. No.
1.
2.
Month Ap ri l May Minimum Month wise guaranteed quantity
8.5% • annual Quantity
8.5 --"- -
3. June 8.5% --"--
4. July 7.5%--"--
5. August 7.5%--"--
6. September 7.5% "
7. October 8.5% "
8. November 8.5% "
9. December 9.0% --" -- 10 J_anuary .1-{ February
9.0% --" --
9.5% --" --
12. March 9.5% --" -- • • l...
t D 208 ( 12) £frefh!-Pl4 m, ~ 23 ~ 2001 Description of Premises (with boundaries) North ........ .. ...... ... ... .. ... .. ... ... .. ............... .
South ................. ........ ... ...... ..... .... .... .. .. .
East.. .......... ....... .... ... .. ..... ...... ..... .......... .
West ... .. .......... .. .... ........... ...... ....... .. ..... ..
Name, Father's Name and Address of Licensee (s) 1 ... .. ... .... ... ....... ...... ..... .......... ... .. ...... ...... . s/o .. .. ..... ....... ... .. .. .... .... ..... ... ..... .... .... ... ..... ... .. r/o ............. .... .. ... .... ................ .. .. .. ......... .... .. .
2 ......... ... ....... ... .... ................. .... .. ...... .... .. s/o ... ........ .... .. .. .... ..... ... .. .... ...... ...... .. .... , ......... r/o ...... ......... ... ....... ... ... ......... .... ...... .... ... ... ... .
Name, Father's Name and Address of Salesmen 1 .... .... .. .. ... ..... ....... .... ... .. ....... ... .......... .. .. . s/o ..... : .......... ........ ... ... ... ... ... ... ....... ... ........... .. rlo ... ......... ..... ... ............... .... ..... ...... ... .......... .
2 .. .... ... ...... .... .. .. . .' .......... ..... .......... ... ... ..... s/o ... .... ..... .. ... ..... ..... ...... ... .... ......... ... ..... .. .. .... r/o ......... ...... ........ ... .. ...... ..... ........ .. .. .. .... .. .... .
3 ... .... .. ...... ....... . ,. , ........... ..... .... .... ........... s/o .. .. .. ......... ........ ... .. .. ... . , .... , .. , .... .. ..... .. .... ..... r/o .. ... ... .. ...... ... ......... ...... .. .. ... ..... .... ... ....... ... .
4 ....... .......... ....... ... ............. .. .. ..... .......... .. s/o .... ... ... ..... .. .. .... ....... .... ..... .... ... ....... ... ....... .. r/o ... ....... .. ....... ... ... ... .......... ... ... ... ... ..... .. ... .. ..
Licence for the retail sale of foreign liquor in standard quart pint and nip bottles is hereby granted to above licence holder(s), at. ... .. .............. .... ... .. ............. .. .. .. ..... ... (place) in P.S ... .. ... .. ... ....... .. ... .... ... Tahsil.. ......... .. ........ .. .. ...... .... .... in the District of .............. ... : ....... : ........ .. ... w.e.f. from ... '. .................... ..... ......... to March 31, 20 .. .. .. .. .. .. ..... .. .... .. ..... ...... .. ... .for which licence fee and security deposit has been paid in accordance with rule 6.
The Licence is subject to the following special and general conditions :- the infraction of any of which or a conviction for any offence under the Chhattisgarh Excise Act 1915 or Narcotic, Drugs and Psychotropic substances Act. 1985 shall make the licensee(s) liable for cancellation of the licence and · forfeiture of security deposit in addition to any penalty imposed under the relevant laws.
GENERAL AND SPECIAL CONDITIONS
1. The licensee can obtain supp ly of the foreign liquor from the wholesale foreign liquor licensee (FL-1O) after making full payment of price of liquor including all taxes, duties, cess etc. leviable from time to time .
2. The retail licensee shal l not charge less than the minimum retail price as fixed under rule 16.
3. Sales at the licensed premises shall . be made only for consumption "Off" the premises. No liquor shall be consumed/drunk "On" the _premises .
4. No quantity less than one standard N,ip bottle of 180 ml of liquor sha ll be sold to any person.
No sale shall be made to a person below the age of 18 years.
5. The sales shall be made in sealed bottles i.e . quarts, pints and nips of foreign liquor of prescribed strength and quantity and which carry security Hologram or secur ity Holographic shrink Sleeves approved by Excise Commissioner as proof of payment of duty.
6. The licensee shall maintain a regular and accurate daily account in the prescrbed register and the account register sha ll be produced for inspection whenever asked by the competent inspecting authority. The licensee shall also furn ish account of sales etc . and facilitate and provide the material and documents required by the inspecting authority
7. The licensee shall store entire stock of foreign liquor in the licensed premises on ly.
8. a. The licensee is liable to lift the entire minimum month wise guaranteed quantity during that month on ly. The quantity left unlifted on the last working day of the month shall be foreited.
b. The indent for the entire minimum guaranteed Quantity of foreign liquor fixed for the month along with cost of liquor including all duties , taxes and cess must be submitted to the wholesale lincesee by 25th day of ·the month .
c. In case the ratail licensee fails to submit the indent by 25th day of the month as above the District' Excise officer/ Asstt. Commissioner Excise shall immediately report the matter to the licensing authority, who shall take action to impose penalty on the amount of gu.aranteed --
9.
1( - ...
208 ( 13 ) quantity less lifted than the fixed monthly guaranteed quantity at the rate of rupees 150/ proof litre and shall adjust the amount equal to the imposed penalty from the security amount and issue a notice to the licensee to replenish the shortfall in security amount within a week and ·also show cause as to why the licence should not be cancelled . If the licensee fails to deposit the amount of deficit in secu rity amount and does not furnish suitable explaination within the stipu lated period, the licence shall stand cancelled and the licensing authority shall take immediate steps to resettle the shop .
The licensee shall affix a conspicuous signboard at the entrance to the shop on which the name of the licensee, designation "Licensed Retail Vendor of Foreign Liquor" locat ion cif the shop, period of licence and such other information · as prescribed by licensing autority in bold lette rs shall be printed.
' The licensee shall not employ any person as salesman who is below 21 years of age or is suffering from any infectious and/or contageous disease, or has criminal back ground. · The licensee shal l not sell to any person more than prescribed limit of foreign liquor.
The sale should not be made to a person below the age of 18 years , police personnel below the rank of . sub-inspector or to a soldier or official in uniform .
The licensee is strictly forbidden . under any pretext whatsoever from tampering with bottles, pints · and nips, their !ables, security Hologram/Shrink sleeve. Pilfer proof seals .
The licensee shall not keep in his licensed premises any spirit, caramel , colour, essence, hologram/ Shrink Sleeve , !ables, capsules, seals or any other noxious material.
The premises in which the shop is situated shall not be used as a place of residence except by the licensee/salesman and his family.
The licensee is- strictly forbidden from having recourse to any form of baladishment or in document to the customer with a view to increas his sales. Gambling and dance programme are strictly forbidden.
The licensed premises shall remajn open for sales on all days from 10.00 am to 10.30 pm . except on 15 August (independence Day),, 2nd October (Gandhi Jayanti) , 26th January (Republic Day) 30th January, (Mahatma Gandhi, Nirwan Diwas) , Holi, Moharram and upto 3 more days as notified for closure by the licensing authority. Licensing author ity may also order closure of shop on account of law and . order or general election, related activity etc . under the provision of relevant laws. No compensation shall be given for the closure of shop on above dates/days.
The licensee shall not be allowed to carry on any other business on the licensed primises except sale of foreign liquor for which ·_ licence is granted.
l. The licensee shall on expiry of the licence, report to the licens ing authority for disposal of baJance of balance stock which will . be disposed off in accordance with rule 18.
ate iistrict Licensing Authority Appli_cation for the grant of licence fo r Retail Sale of Foreign Liquor (for consumption "Off " the premises) in form FL- I D) [ ~;ile ?(c) ] Registration No . ...... .. .. .... .. .... .. ........ .... .. .
(To be ·filled by the office) Excise Year .................... .. ..
Deatails of the shop applied for
1. Name of the District
2. Name of the shop ..... ..... ... .. .. ..... .... .... ....... ......... ..... ........ Tahsil. ... ...................................... .... P.S . ............. .. ... .. ...... .
I ' I I -- I I I I : I I I ;
'I I·' 208 ! 14 )1
3. Licence Fee (Rs.) ....... .. ... ..... .. ... .............. .. .... ...... .. ............. ... .. ... .... ..... ... ............. ......... .. ............ ... ... .... ... (in wo ... .. ...... .... .. .. ... .. .. ... ..... ................. ..... . ... ...... .... .... .............. .... ...... .. .................... .. ...... (in figL
4. Annual Quantity
5. Earnest Mone (Rs.) ......................... .. .. .... ....... ..... ............... ... ........ ... .. : .... .. ....... .. .... ............. .. ........... .... (in word ... .... ..... .. .... ... ............. .. .. ................... ..... ... .... ...... ....... .. ...... ... ........ ....... .................... (in figure:
6. Security Amount (Rs.) ....... .. ... .............. ... ... ........ ... ..... .. ....... .. .... .' .... ... .. ................. ... ...... .......... .... ...... ....... .. ... (in wo .... ...... ...... ........ .......... ................. ... .. .. ...... .................. ......... .. .. ...... ... ....... ... ... ...... ... .. (in figu Details of the applicant (In case of co-ai:,plicant photograph of co-appl icant and details at serial no . 1 to 5 be also givE
1. Name of the Applicant ......... ...... .. .... ....... ... .............. .. ....... .... ...... .. ................. :
2. Father's/Husband's Name .. .......... .... ........ , .... ............. .............. ............ ............ .
3. Age ...... ... ... .. .. ... ... .................... ... .. ........... ...... ....... ... .. .... .... Sex : Male/Female
4. Perm .:1ent address House No. and Locality/Village Police Station Tehsil Distt.
State Telephone No.
5. Present address
6.
House No and Locality/Village Police Station Tehsil Distt..
State Telephon No.
Details of the earnest money deposited a. Bank Draft No. and Date · b Name of Bank The above info rmation is true to the · best of my/our knowledge . In the event of above informat ic being found incorrect, my/our application shall be liable to be rejec.ted anc earnest money sh, be liable to be forfeited . if abo\le details are found to be incorrect subsequent to the grant , licence it shall render my/our licence liable for cancellation and forfeiture of licence-fee and securi· deposit made by me/us. I/we am/ar'e aware that submission of false or incorrect information is penal offence 1 Signature(S) Thumb impression(s) of the aplicant(~ ANNEXURE Affidavit duly verified by Public Notary (Acknowledgement receipt) Received application from Shrvsmt./ku .................... ............ ... .. ... ............... slo ....... ........... .. ...... ......... .. ... ...... ..... ... .... .............. .
wlo., dlo . .. .. ..... ... ...... ... ....... ... .......... .. ............... .... ... .... ................... .. .. ...... .... .. .. .r/0 ..................... .. .................. .. ...... ....... .. .......................... .. ....... ... ..
· foreign liquor shop ....... ........ .... .... ........................... ......... ........ along with affidavit and bank draft for earn es money and entered in the register at serial number .......................... .. .............. ... ........ .. ...... ...... ... ..
Date : .. .. ...... ... ...... ..... ... .. .......... .. .. .
Time: .. .. ... ............... ................... .. .
Signature of person authorizes by District Excise Officer/ Ass~. Commissioner Excise District .. ... .... ... ............. ....... ....... .
By order and in the name of the Governor of Chhattisgarh By order and in the name of the Governor or Chhattisgarh .
K: R. MISHRA. Dcruty Sec retary.