FORMS R.S.IH-A

[See rule 20(1)]

Application for a pass for the transport of rectified spirit (including absolute alcohol) from the licensed premises¹ of a person holding a sale licence or from a Government warehouse or distillery ¹or any licensed distillery or warehouse¹ to the licensed premises of a licensee holding a licence in Form R.S.II. ²Rs. VI or R.S. VI-A².

Name and address of the applicant
Kind of licence held by the applicant and its number and date and by whom granted.

Quantity and description of rectified spirit to be transported.

Kind of spirit	³Proof litres³	³Dozen bottles each of 750 millilitres³	³Dozen bottles each of 500 millilitres³	³Dozen bottles each of 250 millilitres³
	(1)	(2)	(3)	(4)	(5)
Rectified Spirit
Absolute Alcohol

³(4) (a) The amount of fees paid³ any:

Transport Fee
Special Fee
Total fees

(b) Name of the Treasury in which the fees are paid and the challan number and date.

Place to which rectified spirit is to be transported.

Route

Purpose for which rectified spirit is to be transported.

Name and address of the place from which rectified spirit is to be transported.

Kind of the licence held in respect of the premises from which rectified spirit is to be transported and its number and date.

Period within which rectified spirit will be transported.

* These particulars are not to be given in the case of transport of rectified spirit by a person holding a licence in Form R.S.II, incidental to its purpose from a person holding a sale licence in Form R.S.VI

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