FORM D.S. XXXIV

Sir,

I/We wish to export the following quantity of Ordinary Denatured Spirit from _________________________________________ to _________________________________________ and to claim refund of transport fee thereon. The necessary particulars are supplied below:

1. Name and address of the applicant.
2. Form of the licence held under the Act by the applicant and its number and date.
3. Quantity of Ordinary Denatured Spirit to be exported.
4. No. and date of the Transport pass in respect of the consignment from which quantity at 3 above is to be exported.
5. Chalan No. and date showing the payment of Transport fee on the consignment mentioned at 4 above.
6. Amount of Transport fee credited on the chalan shown at 5 above.
7. Export pass No. and date
8. Name and address of the importer

I/We do hereby declare that the contents of this application are correct.

Yours faithfully

_________________________________

Signature.