FORM S.W III—contd.

FORM S.W III—contd.

PART IV

Pass for transport of sacramental wine

(To be handed over to the licensee to accompany the consignment and to be kept by the consignee for his record.)

1. Serial No.
2. Name and Address of the licensee from whom the sacramental wine is to be transported.
3. Quantity of sacramental wine to be transported.
4. No. of authorisation licence held by the consignee.
5. Name and Address of the consignee.
6. Route.

This pass is granted under and subject to the provisions of the Bombay Prohibition Act, 1949, and the rules made there under authorising the transport subject to the following conditions, namely:

1. The consignment shall not be broken in transit.
2. This pass will remain in force upto..................................................... 20

Signature and Designation of the Officer issuing the pass.

Seal of the Officer issuing the pass

Received the above quantity on.......................................................... 20

Signature of the consignee.