FORM C

9951949 : Bom. XXV]	Bombay Prohibition Act, 1949
1
[FORM ‘C’
(See rule 5)
Alcohol Examination Certificate
No. R . . . . . . . . . . . . . . .of . . . . . . . . . .
M. I. Case No. . . . . . . . . . . . . . . . . . . .
Dated . . . . . . . . . . . . . . . . . . . . . . . . . .
From,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Here mention name, designation and address of testing officer.)
To,
(. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . .
. . .. . .. . . . ,  (Here mention the name, designation and address of registered medical practioner.)
Your letter No. . . . . . . . . . . . . . . . . . . . . dated . . . . . . . . . . . . . . . . . . . . . . . .  ,  forwarding
a phial containing blood of Shri/Smt./Kumari. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
of. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . bearing Serial No. . . . . . . . . . . . . . . . . . . . . . . . .
labelled. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . received here on . . . . . . . . . . . . . . . . . . . .
by post/with messenger Shri . . . . . . . . . . . . . . . . . . . . . .of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
sealed/unsealed, seal perfect and as per copy sent/seals  intact device no copy sent.
Result of the test of the blood
The blood contained . . . . . . . . . . . . . . . . . . . . . . . . . .  per cent. W/V of ethyl-alcohol.
Method, Factual Data and Reasons leading to the Result of Blood analysis
(1)Method of Analysis.—Modified Cavette’s  Method  Journal Analytical Chemis-
try,1959, 31, 1908.It is based on oxidation of alcohol by chromic  acid as that in Cavette’s
Method but the oxidation is carried out in vacuum and at room temperature.It takes only  a
fraction of a minute instead of a few hours to complete the reaction.Ketonic bodies are
volatile acids do not interfere in this method.All usual precautions essential in microana-
lytical work mentioned in the paper referred to above have been strictly followed, e.g., all
chemical used  in the test were of reagent quality the apparatus was first  cleaned with hot
chromic acid, then repeatedly with tap water and finally with distilled  water.
2
[It was then
dried in hot air oven.] No grease was used  anywhere in the apparatus.The atmosphere of the
room  where the test was caried out was free from all gases or  suspended impurities.Fresh
glass-distilled water used throughout the test.
(2)Factual Data and Reasons for arriving at the findings pertaining to the blood
sample in question.—
Analysed on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Smell : Nothing to note/Has characteristic smell of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Quantity of blood taken for analysis : 0.5 ml.
Quantity of N/20 dichormate taken : 5.00 ml.
Quantity of N/20 dichormate used up in oxidising alchol in the sample . . . . . . . . . . . . . ml.
1 ml. of N/20 dichromate oxidises 0.000575 gramme of ethlyl-alcohol.
2
[Therefore, 100 ml. of blood contained.
0.000575 x . . . . . . . . .ml. of dichromate used x 100
---------------------------------------------------------------- . . . . . . . . . . . . . . . . . . .gramme of
0.5 0
ethyl-alcohol.]
Signature and Designation of testing officer.
Note.—(1)WV = . . . . . . . . . . . . . . . . . . . . .grammes of ethyl-alcohol in 100 c. c. of blood.
(2)The blood sample was stored  in refrigerator from the time it was received in the laboratory till
it was taken for analysis.
1.Subs. by G. N. of 26-9-1963.
2.Subs. by G. N. of 6-12-1963.