Manual
› FORM C. I. W. IV
Application Form
FORM C. I. W. IV
Application for pass to import duty paid country liquor
(See rule 14)
Form text (extracted)
: Bom. XXV] Bombay Prohibition Act, 1949
FORM C. I. W. IV
(See rule 14)
Application for pass to import duty paid country liquor
Place .......................
Date ........................
To,
The Collector,
District ....................................................................................................
Sir,
I/We .............................................................................................................................. of
...........................................................................................................................................................
(full address)
request you to grant me/us a pass for the import of the undermentioned kind and quantity
of duty paid country liquor from the Distillery situated at ......................................................
in the District of ............................................... in the state of .................................................
to my/ our wholesale licensed premises ....................................................... No situated at.
in Greatcr Bombay *
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . in the District of
............................................................................................ on payment of duty in the State of
Maharashtra.
I/We furnish the requisite information as follows, namely :
(1) Route by which Country Liquor is to be imported ........................
(2) Name address of my/our agent, if any, at the place .......................
(3) Purpose for which country liquor is to be imported ........................
.............................................................................................................................................................
(4) Period of validity of the pass required ........................................................................
1 /we agree to abide by the provisions of the Bombay Prohibition Act, 1949, and the rules,
regulations and orders made thereunder and the conditions on which the pass may be
issued to me/us.
Yours faithfully,
(Signature of the applicant).
*
Strike off the words which are not applicable.
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