ANNEXURE "N" FORM "F" (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 experiences of the applicant :- 4. Place where the video show is proposed to be located, survey number or numbers of the plot or plots :-Village :Taluka :-District :- 5. Site plan drawn to a scale of not less than one fortieth of an inch to a foot covering an area upto (83 metres) 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 :- 6. Possession by the applicant of other places, if any licensed under the Act :- (i) whether in the same locality of elsewhere :- (ii) whether at the time of applying for license or at any previous time :- 7. Distance by public road of the proposed site to the :- (i) nearest video show center :- (ii) nearest permanent or temporary Cinemas :- 8. Interest of the public generally likely to be served by the location of the video :- 9. Population of the place according the latest census figures :- 10. Suitability of the place where the video exhibitions are proposed to be given :- 11. Adequacy of the existing places for the exhibition of video films in the locality : 12. Benefit to any particular locality or localities to be afforded by the opening of a new place of video exhibition :-
