1 [FORM R. S. IV-A

--- Page 1 --- 260 Bombay Prohibition Act, 1949 [1949 : Bom. XXV '[FORMR.S. IV-A [See rule 23 (1)] Application for a pass for the transport (not incidental to purchase) of rectified spirit (including absolute alcohol) (1) Name and address of the applicant (2) Kind of licence held by the applicant and its numbers and date and by whom granted. (3) Quantity and description of rectified spirit to be transported. Kind of spirit *[Proof liters] 2[Dozen bottles *[Dozen bottles ?[Dozen bottles each of 750 each of 500 each of 250 milliliters] milliliters] milliliters] (1) (2) (3) (4) (5) Rectified Spirit Absolute Alcohol (4) Place to which rectified spirit is to be transported. (5) Route. (6) Purpose for which rectified spirit is to be transported. (7) Name and address of the place form which rectified spirit is to be transported. (8) Kind of the licence held in respect of the Premises from which rectified spirit is to be transported and its No. and date. (9) Period within which rectified spirit will be transported I request that a transport pass for the above quantity of rectified spirit may be issued to me. I hereby undertake to abide by the conditions of the transport pass and the provi- sions of the Bombay Prohibition Act, 1949, and the rules, regulations and order made thereunder. Signature of the applicant Place : Date : To, बल एगाव्लणा ए॒..................---००--०-०००००-००-०००- गुणाठ्पश्ा 021)15णल यणाञा ध्यात फटांड2 (0ती ट्ट ................................. ] 1. Subs. by GN. of 19-11-1957. 2. Subs. by GN. of 26-9-1966.