Maharashtra Excise Manual
Certificate

FORM CERTIFICATE 4

[See rule 29]

What this form is for

Form Certificate 4 is a certificate of delivery in which an Excise Officer at the destination confirms that a consignment of duty-paid imported foreign liquor, sent out under an export pass, arrived with its package and receptacle seals intact. It is issued at the importing place after delivery, so the exporter who holds the export pass can show that the consignment reached its stated destination in another state. The form is prescribed under rule 29 of the Maharashtra Foreign Liquor (Import and Export) Rules, 1963.

Form text (extracted)
918 	Bombay Prohibition Act, 1949 	[1949 : Bom. XXV 
 
FORM “CERTIFICATE-4” 
[See rule 29] 
 
No. ............................. 
 
 
Date ........................... 
 
Certified that Mr./Mrs./Miss/Messers. ........................................................................................ 
who has/have been granted an export pass No. ............................................................... dated 
...................................... by ................................................... has/have delivered the duty-paid 
imported foreign liquor as shown below on ......................................... to .................................... 
of ...................................................... in the district of .............................................. in the state of 
..................................................... 
——————————————————	——————————————————— 
 
Kind of Indian-made Number of  Quantity delivered 
  foreign liquor  packages or Litres Strength Proof Remarks 
Duty-paid imported 
foreign liquor 
receptacles 	litres 
———————————————————————————————————————————— 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
———————————————————————————————————————————— 
and that the seals on the packages and receptacles containing the above foreign liquor were intact 
at the time of delivery of the consignment at its destination. 
 
 
 
Signature and designation of the 
Excise Officer at the importing place. 
 
Place :
Original PDF (as scanned from printed manual)
This is a page from the printed 2023 Excise Manual containing the form. It may include manual page headers/footers.