Application by an Individual for Grant of a License for the Retail Sale of Liquor and Other Intoxicants
* Fields are Mandetory
Basic Information :-
Category of License Applied for *
Name & Style of the Premises / Site *
Apply for Additional Bar(s) No of Additional Bar
Names of Additional Bar(s)
District of Proposed site *
Site Type *
Detailed Particulars of site offered *
Applicant Details :-
Name *
Father's /Husband's Name * Nationality *
Residential Status * Email Id. *
Date of Birth * Present Address
Permanent Address Educational *
qualification
Present Occupation Past Occupation
Annual Income of Applicant (Rs.) * PAN No.
Arrange the Capital from *
Business/Sales Experience
Whether the Applicant hold or held any Excise license(s) in West Bengal/in any other State of India
If yes, Licensee Id. *
If so, Full Particulars thereof and if the License(s) is/are not in Force now, how it/they Terminated
Whether the Applicant is holding or ever held any Temporary Bar License
Whether the Applicant are Involved , either Directly or Indirectly in the Manufacture or Sale of any Intoxicant in a Foreign Territory or any State
Bordering upon the State of West Bengal
Whether the Applicant hold a License for the sale of foreign liquor by wholesale
If so, full particulars are to be furnished
Whether any Relatives hold any Excise License in West Bengal
If so, full particulars are to be furnished
Whether the Applicant was ever convicted by a criminal court of a non-bailable offence
If so, full particulars thereof
Whether the Applicant will be in a position to attend and manage the Shop Personally and Independently in his/her own Interest
Special Claim, if any
Site Details :-
Location Category *
Do you have a Valid Food License for the Proposed Site ? (If Applicable)
Generated On : 10/05/2020 <NIC-WBSC> Mobile No : 9641436899-Page No:1
Application by an Individual for Grant of a License for the Retail Sale of Liquor and Other Intoxicants
If Yes, Details *
Is the Proposed Site Owned by the Applicant
If No, Whether NOC from the Land Lord regarding use of Premises to run the Excise License Applied for, has been obtained
Do you have a Valid Food License for the Proposed Site ? (If Applicable)
Estimated Amount of Monthly sales of Foreign Liquor as assessed by the Applicant(Liters) *
* Enter Payment Details Mandetory
* All Documents are Mandetory except Copy of Current Food License issued by Competent Authority (FSSAI) which is not applicable only for
Retail-Hotel cum Bar,Retail-Departmental Store and Copy of NOC of Land Owner if the Offered Site is not owned by the Applicant Document
Applicable only if NOC from the Land Owner regarding use of Premises to run the Excise License Applied for, has been obtained
Generated On : 10/05/2020 <NIC-WBSC> Mobile No : 9641436899-Page No:2
