FORM C.L.XV

(To be sent to the Excise Officer of the exporting Place)

No __________ of 20 __________

Shri/M/s __________________________ having paid into the Government Treasury at __________________________ the sum of Rs __________ (Rupees) __________ only on account of duty on the under mentioned description and quantity of country liquor is/are hereby permitted to import the said country liquor from the Distillery at __________________________ in the district of __________________________ in the state of __________________________ to his/their wholesale (Trade) licensed premises No __________ situated at __________________________ Greater Bombay in the district of __________________________

The consignment shall be conveyed by rail/road, via __________________________ shall be inspected en-route at __________________________ by ¹*] and on arrival at the destination shall be examined at __________________________ by ²**] it shall not be broken in transit

This pass shall remain in force upto the __________ day of __________

This pass issued subject to the provisions of the Bombay Prohibition Act, 1949, the rules, regulations and orders made there under and the conditions specified in this pass.

(Signature) __________________________
Dated __________ 20 __________ Collector ^- __________________________ District

PART II

This pass, together with Part II is forwarded to the Excise Officer __________________________

(Signature) __________________________ __________
Dated __________ 20 __________ Collector __________________________ District