(See rule 18)
Dated ________ ...........
Certified that Shri/Shrimati/Kumari/Messrs who has/have been granted an export pass No dated by has/have been delivered the spirituous preparation as shown below on ..............___ ............. to of----------- ------------- ------------- .... ............... ............... in the district of... ............... ... .... in the State of .... ...----------------- .......----------------- ....----------- - .... ...........
| Name of spirituous or receptacles |
No. of packages or receptacles |
Quantity delivered |
Remarks |
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|
Bulk P.L. |
Strength |
Proof P.L. |
|
|
|
|
|
|
|
and that the seals on the packages and receptacles containing the above spirituous preparation were in tact at the time of delivery of the consignment at its destination.
Signature and designation of the Excise Officer at the importing place.
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