Application for New FL 11 License

Hotel / Premises Details

Name of the Hotel *

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Does the hotel falls under KTDC? *

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Yes

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Address/Premises of Hotel

Building Number *

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District *

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Circle *

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Village *

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Taluk *

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Local Body * Panchayat / Municipality / Corporation

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Desom *

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Pin Code *

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Zone *

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Survey No. *

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Boundaries of the Licensed Premises

East By *

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North By *

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West By *

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South By *

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Boundaries of the Beer/Wine Room

East By *

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North By *

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West By *

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South By *

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Distance from nearest objectionable institution (in Mtr) *

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Nearest objectionable institution *

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Applicant Details

Name of Applicant *

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Designation *

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Address Line 1 *

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Address Line 2

Address Line 3

Country *

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State *

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District

Postal / Zip Code *

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Aadhaar Number

Mobile Number *

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Ownership Details

Ownership Status *

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Serial No. of the firm *

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Name of Firm *

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Date of Registration *

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CIN/LLPIN *

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Company/ LLP NAME *

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Proprietor Details

Name *

Designation *

Address *

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Partner/Director Details

Name *

Designation *

Address *

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Licensee Details

Name & Address of the persons against whose name, the license has to be issued

Name *

Address *

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Classification Details

Star Classification of Hotel *

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Whether Classification Certificate issued by HRACC/Tourism/HRACC? *

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Yes

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Classification Certificate No. *

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Classification Certification Date *

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Validity End Date of Classification Certificate *

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Please Specify the Employee Social Assistance Certificate Obtained by the Licensee

EPF Certificate Number *

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AWWF Clearance Certificate Number *

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Arrears / Modifications

Whether the licensee or any of the Partners / Directors have any arrears *

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Yes

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Furnish Details *

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Furnish Details if 50% of such Arrears have been Cleared at the Time of Renewal

Whether the Licensee/Partner/Directors have been convicted for any offence? *

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Yes

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Furnish Details *

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Whether any Alteration/Modification been made in the Premises *

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Yes

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Furnish Details *

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Whether any Alteration/Modification have been made in the Ownership Deed *

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Yes

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Furnish Details *

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Details of Service

Would You like to Serve Beer/Wine in Restaurant *

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Yes

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Would You like to Serve Beer/Wine in Lawn / Swimming Pool / Roof Garden *

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Yes

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Would you like to Possess and Sell Foreign Made Foreign Beer/Wine *

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Yes

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Beer/Wine serving in Banquet Hall *

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Yes

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Please Specify Number of Additional Rooms for serving liquor *

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Please Specify Number of Service Desks sanctioned *

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Affidavit

I/We hereby declare that the statements furnished by me are true and correct to the best of my knowledge and belief. I also declare that I am eligible for grant of licence under the present laws and rules and neither me nor any of the partners of the firm/Directors of the company for which the licence is given are guilty of any breach of laws/Rules/Licence condition which disqualify me/them from grant of this FL11 licence.

I Agree *