ANNEXURE "M" FORM '"B" (Rule 17) APPLICATION Dated:- Signature of the applicant 1. Full name of the applicant:- 2. Address of the applicant:- Village:- Taluka:-District:- 3. Status and previous experience of the applicant:- 4. Is the application for a permanent or touring cinema:- 5. Place where the cinema is proposed to be located, survey number or numbers of the plot or plots :-Village :Taluka :-District:- 6. Site plan drawn to a scale of not less than one fortieth of an inch to a foot covering an area upto 200 years from the boundaries of the proposed site showing : (i). The position of the proposed premises in relation to any adjacent premises and to the public thorough - fare upon which the site of such premises abuts; and :- (ii) thatched sheds, if any, in the neighbourhood :- 7. Possession by the applicant of other places, if any licensed under the Act :- (i) whether in the same locality or elsewhere :- (ii) whether at the time of applying for license or at any previous time :- 8. Distance by public road of the proposed site to the :- (i) nearest permanent Cinema :- (ii) nearest touring cinema :- (iii) nearest school :- (iv) nearest hospital :- (v) nearest temple or other religious institution 9. Interest of the public generally likely to be served by the location of the cinema : 10. Population of the place according to the latest census figures:- 11. Suitability of the place where the cinema exhibitions are proposed to be given :- 12. Adequacy of the existing places for the exhibition of cinema films in the locality :- 13. Benefit to any particular locality or localities to be afforded by the opening of a new place of cinema exhibition :-