FORM R.S. V

[See rule 23(1)]

Pass for the transport (not incidental to purchase) of rectified spirit (including absolute alcohol)

PART I

(Counterfoil)

Serial Number .. ..
Name and address of the person transporting the rectified spirit (including absolute alcohol).

Licence Number of the transporter

Quantity and description of the spirit

Kind of spirit	²[Proof liters]²	²[Dozen bottles each of 750 milliliters]²	²[Dozen bottles each of 500 milliliters]²	²[Dozen bottles each of 250 milliliters]²
(1)	(2)	(3)	(4)	(5)
Rectified Spirit
Absolute Alcohol .. ..

Route. .. ..
Place from which rectified spirit is to be transported.
Place to which rectified spirit is to be transported.
Purpose for which rectified spirit is to be transported.
Date upto which the pass shall be valid

This pass is granted under and subject to the provisions of the Bombay Prohibition Act, 1949, and the rules made there under authorising the abovementioned

The consignment shall not be broken in transit.

Dated:

Signature of the Officer issuing the pass.

Designation

Seal of the Officer issuing the pass

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