FORM "CERTIFICATED"
[See rule 29)]
Date ............
Certified that Mr./Mrs./Miss/Messrs who has/have been granted an export pass No dated by has/have delivered the duty-paid imported foreign liquor as shown below on to of in the district of . ..................... in the state of
| Kind of Indian-made foreign liquor Duty-paid imported foreign liquor | Number of packages or receptacles | Quantity delivered Litres | Strength | Proof | Remarks |
|---|---|---|---|---|---|
and that the seals on the packages and receptacles containing the above foreign liquor were intact at the time of delivery of the consignment at its destination.
Signature and designation of the Excise Officer at the importing place.
Place: