CERTIFICATE I
[See rule 20 (3)]
Dated
Certified that Shri/Smt./Kum./Messrs of who has/have been granted transport pass No dated by has/have delivered the potable liquor as shown below on ................................ to of in the district of
| Variety of liquor | Number contained in each (bottle) | Quantity litres | Total litres | Strength | Proof | Remarks |
|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
and that the seals on the packages and receptacles containing the above potable liquor were in tact at the time of delivery of the consignment at its destination.
Signature and designation of the Officer at the destination place.
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