FORM DS.R £ (See Rule-20) (E^qtort passfar denatured spirituous preparations) Part-IV

SealCoDectorof. .......... ............

FORM DS.R £ (See Rule-20) (E^qtort passfar denatured spirituous preparations) Part-IV

Ib be forwarded to the Collector or ChiefExcise authority of the place of import

Serial No. dated ......._____ ......... 197 .

Shri / Sarvashri ......... ........ ......... .......... .... ..... of... ... .... ... holding .... .... D.S.R licence No of.... is/are hereby granted a pass under and subject to the provisions of the Bombay Prohibition Act, 1949 (Bom. XXV of 1949), and the rules, regulations and order made there under authorising him / them to export litres/bottles of the following denatured spirituous preparations, namely:—

from ............. ...................................................................................................................... of......…...….. .... .......... ......................----- .............. to----- ............-------- .........................his/their shop/premises situated at ........ .... ........___ .......... ...... ............................................................ via ...................................(route), subject to the following conditions, namely:— —

1. The pass shall remain in force upto ............. ----- .........------------ .........-------- ....
2. The quantity of denatured spirituous preparations shall be exported in one consignment only and its bulk shall not be broken in transit.

Seal Collector of.