| 1. |
Name of the Applicant with Address and Phone No. |
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| 2. |
Address of the proposed premises |
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| 3. |
Dimension and carpet area of the premises
(minimum 400 sq.ft) |
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| 4. |
Police Station where the premises is located |
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| 5. |
Location of premises
- Approved Commercial area
- Green/ Agriculture land
- Unauthorised Market (Please attach proof.)
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| 6. |
Where the applicant is owner of the proposed premises (Please attach proof) |
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| 7. |
If applicant is a tenant 'No Objection' from landlord for running a liquor Shop in the proposed premises through DSIIDC to be attached. |
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| 8. |
Percentage of rent compensation asked by the applicant. |
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| 9. |
Please give the exact distance and status of following within 75 mtr. from the proposed shop. |
: Distance Status |
| 10. |
a) Industries Units
b) List of education institutes and Primary/Hr. Scc./College
c) List of religious places (Temple/Mosque/Church/Gurdwara).
d) List Nursing Homes/Hospitals please mention number of beds in each.
e) Harijan/Labour Colony
f) Construction Site
g) No. of shops in the MKT. and type of business being conducted therein.
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(SIGNATURE OF APPLICANT)
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