FORM D.S. XXXV

: Bom. XXV] Bombay Prohibition Act, 1949 FORM D.S. XXXV [See rule 50-A (2)] Name and Address of the Licensee................... .... D.S. VI Licence No. ............................... ... Month ............................................. .....19 ——————————————————————————————————————————————————————————— No. and date of Transport pass Chalan No. and date showing the Amount of transport fee Serial No. Date of the consignment from which payment of transport fee as credited on the chalan Quantity of ordinary Export pass consignment from which ordinary the consignment mentioned shown in column 4 denatured spirit to be No. and date denatured spirit is to be exporied in column 3exported 1 2 3 4 5 6 7 —————————————————————————————————————————————————————————————————————— —————————————————————————————————————————————————————————————————————— —————————————————————————————————————————————————————————————————————— Name and Address of the importer Signature of the District Claim for rerfund of transport fee on No. and date of the Excise authority of the Prohibition Excise Officer ordinary denatured spirit to be importing State certifying the receipt of the exported quan tity of ordinary denatured spirit imported 89 1 01 1 —————————————————————————————————————————————————————————————————————— —————————————————————————————————————————————————————————————————————— —————————————————————————————————————————————————————————————————————— Initials of the District Prohibition and Excise Date and No. of refund bill Amount of refund bill Date of payment Officer 1 21 31 4 1 5 —————————————————————————————————————————————————————————————————————— ——————————————————————————————————————————————————————————————————————