FORM “CERTIFICATE-3”

FORM “CERTIFICATE-3” [See rule 25 (3)] No. Dated .................................... 915 Certified that Mr./Mrs./Miss/Messers. ....................................................................................... .................................................of ........................................................................... who has/have been granted an export pass No. ......................................................... dated ....................................... by .......................................... has/have delivered the Indian-made foreign liquor as shown below on ................................................................ to ............................................ of ..................................... in the district of ............................................ in the State of .................................................. ————————————————————————————————————— Description of Indian Number of packages Quantity delivered Remarks made duty paid imported foreign liquor or receptacles Litres Strength Proof litres ————————————————————————————————————— ————————————————————————————————————— and that the seals of the packages and receptacles containing the above foreign liquor were intact at the time of delivery of the consignment at its destination. 1 [*2. The importer has paid all duties and fees leviable under the Bombay Prohibition Act, 1949 on the quantity of Indian-made foreign liquor mentioned in the export pass, according to the rates prevailing in this State.] Signature and designation of the Excise Officer at the importing place. Place : ————————————————————————————————————— * Strike off if not applicable. 1 Ins. by G.N. of 7-7-1971.