FORM D.S. XXXIV

: Bom. XXV] Bombay Prohibition Act, 1949 FORM D.S. XXXIV [See rule 50-A (i)] Application for the refund of Transport Fee ‘A’ Dated 19 To, The Superintendent/District Inspector of Prohibition and Excise, Sir, I/We wish to export the following quantity of Ordinary Denatured Spirit from .................................................................. to ..........................................................................and to claim refund of transport fee thereon. The necessary particulars are supplies below : 1. Name and address of the applicant. 2. Form of the licence held under the Act by the applicant and its number and date. 3. Quantity of Ordinary Denatured Spirit to be exported. 4. No. and date of the Transport pass in respect of the consignment from which quantity at 3 above is to be exported. 5. Chalan No. and date showing the payment of Transport fee on the consignment mentioned at 4 above. 6. Amount of Transport fee credited on the chalan shown at 5 above. 7. Export pass No. and date 8. Name and Address of the importer. I/We do hereby declare that the contents of this application are correct. Yours faithfully Signature. 430 Bombay Prohibition Act, 1949 [1949 : Bom. XXV ‘B’ No. Checked and found correct according to the documents produced by the applicants. Date 19 Superintendent/District Inspector of Prohibition and Excise,................ ———————————————————————————————————— ‘C’ No. Date 19 The quantity of ordinary denatured spirit mentioned at item No. 3 of the applicant has been correctly received by the importer. Signature and designation of the excise authority in whose jurisdiction the place of import is situated.