(Reverse)

SeNo

FORM CX. XIV
See rule 7(2)
Pass for the transport of duty paid country liquor as detailed on the reverse
(Original)
(To be retained by the Manufactory Officer)

(1) Ref of relevant page No. of Register in Form C.L.X.
(2) Name and address of the transporter.
(3) Place to which the country liquor is to be transported.

(4) Place from which country liquor is to be transported.

(5) Route (i.e. by road or rail) by which country is to be transported (State here the places via which the consignment will be sent).

The consignment shall not be broken in transit. This pass shall remain in force upto and including 19 .

Seal

Place:

Date : Manufactory Officer

(Reverse)

Details of the country liquor allowed to be transported from
(Here state the name of the Manufactory)

Variety of country liquor	Strength	No. of Bottles	Total B. Litres
(1)	(2)	(3)	(4)

Place :

Date : Manufactory Officer.

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