* Strike out if unnecessary [see rule 5 of Bombay Foreign Liquor and Rectified Spirit Transport Fees Rules, 1954].
(See rule 6)
Dated
Certified that Mn/Mrs. Miss/Messrs........
of----------------------------------------------------- ................. who has/have been granted
an import pass No..............................................
bv...................................................................... ......... has/have been issued duty-paid
imported foreign liquor from the shop of...... ................... of.......................................
as shown below :
| Description of duty paid imported foreign liquor |
No. and description of each kind of receptacle |
Marks and Numbers on packages or receptacles |
Capacity of each receptacle or packages |
Actual contents litres |
Proof Strength litres |
and that the receptacle and packages containing the said foreign liquor are securely packed in my presence and sealed with my official seal.
Signature and designation of the
Place Excise Officer at the exporting place.