FORM BR-XII

I/We bind myself/ourselves that I/we shall cause the quantity of beer/wine mentioned in the pass to be duly and safely transported from the brewery/manufactory of and conveyed it by the most direct route from to aforesaid in conformity with the provisions of the Bombay Prohibition Act, 1949 and the rules, regulations and orders made there under, and shall cause the said beer/wine to be delivered into the custody of at in the district of and shall procure and produce to the Brewery/Manufactory Officer within two months from the date of this bond a certificate signed by the Excise Officer aforesaid showing what quantity of the said beer/wine specified in the pass has been delivered at the aforesaid.

And that if the whole quantity shall not have been delivered to the at aforesaid, I/We, my/our heirs, executors, administrators and representatives shall on demand by the District Prohibition and Excise Officer pay or cause to be paid within seven days from the date of demand to the said officer, duty, transport fee and special fee mentioned in the Bombay Foreign Liquor and Rectified Spirit (Transport) Fees, Rules, 1954 at the rates in force on such portion of beer/wine specified in the pass as shall not be so delivered; and that in the event of my/our failure to pay the amount of the said duty and fees within the said period of seven days, I/we, shall pay interest on the said amount at the rate of 12 percent per annum from the date of demand to the date of payment.

And in case of my/our making default in the payment of the said duty, fees interest and other charges, if any, I/we bind myself/ourself to forfeit to the Governor of Maharashtra, the sum of Rupees

Place

Dated this day of 197

In the presence to—

② Signature of the licensee or transporter

Before me

District Prohibition and Excise Officer, ¹