FOR TTB USE ONLY	DEPARTMENT OF THE TREASURY ALCOHOL AND TOBACCO TAX AND TRADE BUREAU APPLICATION FOR AND CERTIFICATION/EXEMPTION OF LABEL/BOTTLE APPROVAL (See Instructions and Paperwork Reduction Act Notice on Back)
TTB ID 14259001000117
1. REP. ID. NO. (If any) CT 451 OR 4D

PART I - APPLICATION
2. PLANT REGISTRY/BASIC PERMIT/BREWER'S NO. (Required) NJ-I-15203 3. SOURCE OF PRODUCT (Required) Domestic Imported	8. NAME AND ADDRESS OF APPLICANT AS SHOWN ON PLANT REGISTRY, BASIC PERMIT OR BREWER'S NOTICE. INCLUDE APPROVED DBA OR TRADENAME IF USED ON LABEL (Required) PROXIMO SPIRITS, PROXIMO SPIRITS, INC. 333 WASHINGTON ST , 4TH FLOOR JERSEY CITY NJ 07302
4. SERIAL NUMBER (Required) 140005 5. TYPE OF PRODUCT (Required) WINE DISTILLED SPIRITS MALT BEVERAGE
6. BRAND NAME (Required) RON MATUSALEM	8a. MAILING ADDRESS, IF DIFFERENT
7. FANCIFUL NAME (If any) GRAN RESERVA 23

9. EMAIL ADDRESS	10. GRAPE VARIETAL(S) (Wine Only) N/A	11. FORMULA	18. TYPE OF APPLICATION (Check applicable box(es)) a. CERTIFICATE OF LABEL APPROVAL b. CERTIFICATE OF EXEMPTION FROM LABEL APPROVAL "For sale in _______ only" (Fill in State abbreviation.) c. DISTINCTIVE LIQUOR BOTTLE APPROVAL. TOTAL BOTTLE CAPACITY BEFORE CLOSURE ____ _____ (Fill in amount) d. RESUBMISSION AFTER REJECTION TTB ID. NO. ______
12. NET CONTENTS 750 MILLILITERS	13. ALCOHOL CONTENT 40	14. WINE APPELLATION IF ON LABEL
15. WINE VINTAGE DATE IF ON LABEL	16. PHONE NUMBER (201) 204-1723	17. FAX NUMBER (201) 221-8074
19. SHOW ANY INFORMATION THAT IS BLOWN, BRANDED, OR EMBOSSED ON THE CONTAINER (e.g., net contents) ONLY IF IT DOES NOT APPEAR ON THE LABELS AFFIXED BELOW. ALSO, SHOW TRANSLATIONS OF FOREIGN LANGUAGE TEXT APPEARING ON LABELS. BRAND NAME, PRODUCER NAME, AND GRAPHICS MAY REPEAT ON CAP, CAPSULE OR BOTTLENECK. ON THE STRIP LABEL THE FOLLOWING SENTENCE APPEARS IN SPANISH: "ELABORADO CON SELECTOS AÑEJOS DE LAS RESERVAS ESPECIALES DE MATUSALEM.¿ ENGLISH TRANSLATION IS: ¿MADE WITH SELECTED AÑEJOS (EXTRA AGED) FROM MATUSALEM SPECIAL RESERVES.¿

PART II - APPLICANT'S CERTIFICATION
Under the penalties of perjury, I declare; that all statements appearing on this application are true and correct to the best of my knowledge and belief; and, that the representations on the labels attached to this form, including supplemental documents, truly and correctly represent the content of the containers to which these labels will be applied. I also certify that I have read, understood and complied with the conditions and instructions which are attached to an original TTB F 5100.31, Certificate/Exemption of Label/Bottle Approval.
20. DATE OF APPLICATION 09/16/2014	21. SIGNATURE OF APPLICANT OR AUTHORIZED AGENT (Application was e-filed)	22. PRINT NAME OF APPLICANT OR AUTHORIZED AGENT DAISY MENA

PART III - TTB CERTIFICATE
This certificate is issued subject to applicable laws, regulations and conditions as set forth in the instructions portion of this form.
23. DATE ISSUED 10/25/2014	24. AUTHORIZED SIGNATURE, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU

FOR TTB USE ONLY

QUALIFICATIONS TTB has not reviewed this label for type size, characters per inch or contrasting background. The responsible industry member must continue to ensure that the mandatory information on the actual labels is displayed in the correct type size, number of characters per inch, and on a contrasting background in accordance with the TTB labeling regulations, 27 CFR parts 4, 5, 7, and 16, as applicable. STATUS THE STATUS IS APPROVED. CLASS/TYPE DESCRIPTION CUBAN RUM WHITE FB

EXPIRATION DATE (If any)

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AFFIX COMPLETE SET OF LABELS BELOW

Image Type:

Brand (front) or keg collar
Actual Dimensions: 3.05 inches W X 2.5 inches H

Image Type:

Back
Actual Dimensions: 2.2 inches W X 1.41 inches H

Image Type:

Strip
Actual Dimensions: 3.54 inches W X 1.3 inches H

Image Type:

Other
Actual Dimensions: 3.35 inches W X 1.28 inches H

Image Type:

Other
Actual Dimensions: 2.97 inches W X 1.9 inches H

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