FORM “CERTIFICATE-1”

————— FORM “CERTIFICATE-1” (See rule 6) No. ............................................................... Dated ............................................................ Certified that Mr./Mrs. Miss/Messrs........................................................................................... of ................................................................................................... who has/have been granted an import pass No. ............................................... dated ................................................................... by ............................................................................................ has/have been issued duty-paid imported foreign liquor from the shop of ............................................... of ..................................... as shown below : _____________________________________________________________________ Description No. and Marks and Capacity Actual Proof of duty paid description Numbers on of each contents Strength litres imported of each kind packages or receptacle litres foreign liquor of receptacle receptacles or packages _____________________________________________________________________ _____________________________________________________________________ and that the receptacle and packages containing the said foreign liquor are securely packed in my presence and sealed with my official seal. Signature and Designation of the Place ........................................... Excise Officer at the exporting place.