FORM F. L. R. 10

: Bom. XXV] Bombay Prohibition Act, 1949 FORM F. L. R. 10 [See rule 16 (4)] Register showing full names and addresses of registered medical practitioners on whose prescription champagne. Port-type Wine, Port-Wine, Wincarnis, Vibonas, Manola and Bukfast Tonic Wine, were sold by the licensee and of the persons to whom they were sold. Licence No. . . . . . . . . . . . . . . . . Name of the licensee . . . . . . . . . . . . . . . . . . —————————————————————————————————————–––––––––– Name of registered medicalName of persons Name and practitioners on whose pre-to whom Cham-quantity of scrtiptions Champagne, pagne or Port-wine prescribed etc. is sold by wine is sold onand sold prescription licensee prescription ———————————————————————————————————— Date No.Date FullAddressRegistra-FulAddressNameQuantity Name tion No.Name of winesold ml. ml. (1) (2) (3) (4) (5) —————————————————————————————————————–––––––––– —————————————————————————————————————–––––––––– —————————————————————————————————————–––––––––– Name and total quantity ofWhether the totalSignature of the wine sold on prescriptionsquantity has been licensee or his Cash during the day entered in the stockauthorised Remarks memo No.––––––––––––––––––––– register of the servant Name of Quantity licensee and if so, wine ml. at what page ml. (6) (7) (8) (9) (10) —————————————————————————————————————–––––––––– —————————————————————————————————————––––––––––