Quotation for Transportation of IMFL/Beer stocks from IMFL

Depot to Retail Outlets within ________________ District

1. Name of the Applicant :
2. Fathers/Husbands Name:
3. Permanent Residential address:
. a! "# Proof : A#HAAR / PAN / #R"$"N% &"'(N)(
b! Address Proof : RA*"+N 'AR# / (&('*"+N,$+*(R 'AR#)
-. Present Address:
.. /uoted Amount per 'ase/per 01
includin2 &oadin2 3 4nloadin2 'har2es in Rs.
for the follo5in2 slabs.

#istance in
0ms
Amount per 'ase/0m
672-
2.7-6
-178-
8.7166
161712-
12.71-6
1-1718-
18.7266

Sinature
of !pplicant