[See rule 13(1)]
Application No. __________ of 20__________
Application for clearance of beer/wine on payment of duty and transport fee from the brewery/manufactory .............................................................................................................
| No. and Date of entry in the register in Form BR-VII | Batch No. | Variety of Beer/Wine | Bulk in litres | No. of each kind of bottle/cask/kegs | Contents in each kind of bottle/cask/kegs (LJml.) | Strength |
|---|---|---|---|---|---|---|
| (1) | (2) | (3) | (4) | (5) | (6) | (7) |
| Marks and Number of containers | Rate of duty | Amount of duty paid | Challan No. and Date | Rate of transport fee | Amount of transport fee paid | Purpose for which cleared | Remark |
|---|---|---|---|---|---|---|---|
| (8) | (9) | (10) | (11) | (12) | (13) | (14) | (15) |
I declare that the above particulars are true and correctly stated. I apply for leave to clear the above beer/wine for the purpose stated in column (14) above.
The beer/wine will be transported to __________ (here mention the place where the consignment will be transported) by __________ (here mention the route i.e., rail or road).
Place: __________
Date: __________
The Brewery Officer/Manufactory Officer.
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