annexure 1
APPLICATION FORM FOR PREMISES LICENCE FOR A CYBER CAFÉ
To,
The Commissioner of Police,
Desk-X,(Theatre Branch),
Brihan Mumbai.
Sub :- Application for the grant of premises/performance licence for Cyber café providing services of internet/intranet connectivity in a public place
Sir,
I, the undersigned, Shri/Smt/Kum_______________________________________ Owner/Proprietor of Cyber Café (as defined under section 2(9) of Mumbai Police Act-1951, definition of place of public amusement), by name ________________ _______________________________________________ hereby apply for grant of premises licence at the following address.
The place belongs to me/us taken on rent/ is on lease/leave and licence.
Details are as follows[1] :-
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1.
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Full Name of Applicant-Owner
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2.
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Address
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3.
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Telephone number(s)
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4.
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Fax
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5.
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Email
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6.
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Occupation
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7.
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Date of birth
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8.
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Nationality
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9.
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Name of Cyber Café
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10.
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Address of Cyber Café (or, if at more than one location, of each location; use separate sheet, if necessary)
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11.
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Other name, if any, of the establishment
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12.
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Whether premises are owned, leased, rented or taken on leave and license by applicant-owner? (Specify)
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13.
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If on rental, lease or leave and license, period of tenancy/lease/license
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14.
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Approximate sq ft area of premises
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15.
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Telephone numbers at the Cyber Café with the name and address of the telephone subscriber (use separate sheet if necessary)
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16.
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Email addresses of the cyber café
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17.
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Exact nature of activities at the cyber cafe, (attach separate sheet if required) (eg also serving beverages and snacks, etc)
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18.
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Name and address of conductor or operator of Cyber Café if other than applicant-owner
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19.
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Number of branches
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20.
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Whether a similar license has been applied for; if so, give details.
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Copies of documents attached
(tick all that are applicable)
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1. Shops & Establishments License
2. Eating house licence.
3. Grade Licence.
4. Health Department licence in Form “B”.
5. F.L. III Licence.
6. P.P.E. Licence
7. Copy of partnership deed, if partnership firm.
8. Rent Receipt, if the place is on rent/ lease
9. Tax assessment/paid receipts
10. Certificate from Govt. Elctrical contractor/ Private contractor regarding the safeness of electrical fittings
11. Document from fire brigade to the effect that all precautionary measures are taken from public safety point of view
12. Bill of fire fighting equipment of current year.
13. Certificate from MTNL telephone is in working order or has been duly installed in the premises.
14. Site plan showing religious, educational institution and hospital within a radius of 100 mtrs.
15. Ownership documents if the place is owned by the applicant.
16. Occupation/ commencement certificate of B.M.C. stating “NO ACTION PENDING”
17. Copy of memorandum & articles of association, if any
18. Copy of the resolution, if any, under which authorized to sign and obtain the above licence from Police Department.
19. Certificate from the ISP regarding particulars of ISP connection including user name and allocation of static(fixed) IP address.
20. Undertakings and indemnities in the prescribed pro-forma (below)
21. Certificate from the ISP that the applicant is allowed to share, resell, distribute the ISP services in any manner.
22. Full particulars of number of machines installed, along with hardware configurations of each client and server machine, all peripherals (list modems, scanners, webcams, microphones, audio systems) with make and brand
23. Particulars of licensed software installed on each machine including Operating System Software and other application software.
24. Particulars of software being used for prevention of access to pornographic and objectionable web sites
25. Particulars of internal networking computers and other peripherals and the site map of the network along with Ethernet addresses.
26. Particulars of Hardware/software Engineer/consultant.
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Copies of above documents are attached herewith.
If any other documents are required the same will be submitted as soon as we are informed.
Thank you,
Yours faithfully,
(Full Signature)
PRO FORMA UNDERTAKING
(On Rs. 100/- Stamp Paper)
I , __________________________s/o, d/o, w/o ________________________, an adult Indian Inhabitant, aged _____ Yrs., residing at __________________________________ __________________________________________________________ do hereby solemnly affirm and state as follows:
A. I say that I am the Sole Proprietor/Partner/Owner of M/s._________________________ situated at (postal address) __________________ _____________________________________________.
B. I say that I have familiarized myself with the laws and regulations in force which concern the operation of my Cyber Café and accordingly I hereby give the following undertaking :-
1) that I will maintain logs of IP addresses as allocated within to all machines within the Cyber Café along with corresponding time and date stamps of such allocations.
2) that I will comply with the provisions of the Cable Television Network (regulation) Act 1995, Indian Telegraph Act, 1855, Indian Wireless Telegraphy Act, 1933, Indian Copyright Act, 1956, Information Technology Act, 2000, Bombay Police Act, 1951 and their respective rules and guidelines. I shall also comply with the guidelines on Internet Services and usage no. 845-51/97–VAS and the rules made under the relevant Acts;
3) that I shall permit use of the Cyber Café only against production of a suitable photo id card. I shall ensure that no unauthorised or illegal activity takes place within the said premises;
4) that I will ensure that minors shall be allowed to use only those machines that are in the common open area and not any machine that is behind a partition or in a cubicle, cabin or other similar enclosure.
5) that I will extend full co-operation to the law enforcing agencies, Courts, Government, Statutory and other Competent Authority by immediately providing them with all records / documents as and when called upon to do so;
6) that I will regularly supply and provide information in the prescribed time to the Licensing Authority, as provided under the Rules for Licensing and Controlling Places of Public Amusement (other than Cinemas) and Performances for Public Amusement including Cabaret Performances and Tamashas-1960 (public amusement rules in short) framed by the Commissioner of Police, Greater Mumbai under section 33 of Bombay Police Act – 1951;
7) that I will ensure and maintain the correctness of date and time on the computer system in the said Cyber Cafe;
8) that I will inform the Licensing Authority immediately the particulars of any changes in the data storage media (eg hard disks, tape drives, zip drives, JAZ drive, CD/DVD RW and other similar hardware for storage media) made with the computer systems in the said Cyber Café and also to the Cyber Crime Investigation Cell, Mumbai;
9) that I shall provide necessary Indemnity Bond in the prescribed form to indemnify the Licensing Authority i.e. Commissioner of Police, Brihan Mumbai for any infringement against any loss, damage, cost etc. caused occasioned by the issue of license / the activities in my Cyber Café.
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Solemnly affirmed at Mumbai, this ________ day of ____________ 2002 ... ... ... ... ... ... ... ...
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Before me,
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Identified by me:-
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Notary Public
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DRAFT INDEMNITY BOND
(To be typed on Rs.200/- Stamp Paper)
To,
The Commissioner of Police
Brihan Mumbai.
WHEREAS Mr./Mrs./Ku______________________________ s/o, w/o, d/o _______________________, adult, Indian Inhabitant, aged_____________ is residing at _______________________________________________________________is desirous of obtaining a Premises Licence for the purpose of conducting business of a Cyber Cafe known as M/s. ____________________ situated at ____________________________________________________________________.
AND WHEREAS the Commissioner of Police, hereinafter referred to as the Licensing Authority (which expression shall include his successors and assigns) at our request will be considering our request for a licence for conducting the business of Cyber Café on such recommendation from competent authorities and indemnity as is hereinafter contained.
In consideration of the grant of such license, we hereby jointly and severally agree to indemnify and keep indemnified the Commissioner of Police against all costs, demands, charges and expenses arising out of any dispute, litigation or claim in respect of the said Cyber Cafe M/s.______________________________ and the amounts demanded by the Commissioner of Police hereunder shall be paid without any protest or demur.
AND IT IS FURTHER HEREBY AGREED
1. That the license, if granted, shall not be transferable.
2. In the event of my/our transferring our right, title or interest in the premises known as ________________ Cyber Café, I/we undertake to inform the Licensing Authority of the same with full details as prescribed within the stipulated period. We further undertake that till such time as the necessary information and details are provided I/we will continue to be liable under this agreement/undertaking.
3. That the authority to determine “cost” in each case or matter shall rest exclusively with the Commissioner of Police, Mumbai and that it shall be binding on us to pay such costs arising out of the dispute as may be determined without question.
4. That this indemnity shall remain in force notwithstanding the absence or non availability of us or either of us or our or either of our legal heirs from India on one or more occasions and shall continue to take effect as if he/she/they or any of them had not left Mumbai or India.
5. That this undertaking and agreement shall be deemed to form part of and be a condition of the license applied for.
Dated :
In the presence of –
1. __________________________
(WITNESS)
_______________________________
SIGNATURE
2. __________________________
(WITNESS)
[1] If more than one applicant details of each applicant be provided
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