Application for Premises & Performance Licence for Social

Club/Card Room.
5/- Rs. Court
fee stamp
CFCTL No._____________
Date___________________

1 Full name of the Applicant/Owner & his

age.

2 Residential Address

3 Telephone no. of Resident.

4 Full name of the Manager & his age.

5 Name of the Social Club/Card Room

6 Address of the Social Club/Card Room

7 Telephone no. of the Social Club/Card

Room

8 Types of Games played in the Social

Club/Card Room

9 Aim of the Social Club/Card Room.

10 Total no. of members

11 Total no. of Rooms in establishments

12 Total no. of Tables in each Room

13 No. of Registers kept in establishments &

their names
14 Whether I card is issued to members

15 How many players are playing with each

Table
16 Enclose following documents.

1. Plan of the Premises.

2. Premises papers.& BMC approved
Plan.
3. Certificate issued by Elec. Insp.
4. Certificate issued by Tel. Exchange.
5. NOC issued by owner of Premises
6. R/C issued by Public Trust/
Dharmaday Ayukta
7. List of Members with Resi. Address &
Member No., Contact No. & Job or
Business, Tel. & Mobile No.
8. List of Committee Members with
Resi. Address & Member No.& Date,
Job or Business, Tel. & Mobile No.
9. Character Certificate of Comm.
Members.
10. NOC issued by C.F.O.
11. Memorandum & Articles of Asso.
12. BMC Health Certificate.
13. NOC issued for construction (In case
of new construction.)
14. Undertaking that no gambling is
allowed.

Signature of the Applicants