FORM "CERTIFICATE"
(See rule 6)
Dated ..........
Certified that Shri/Shrimati/Kumari/Messrs who has/have been granted an import pass No dated ........... by has/have been issued spirituous preparation from the premises of of as shown below:—
| Name of the spirituous preparation | Number and description of each kind of receptacle or package | Marks and Nos. on packages or receptacles | Quantity contained in each receptacle or package | Strength |
|---|---|---|---|---|