Manual
› THE BOMBAY FOREIGN LIQUOR RULES, 1953
› FORM A
Form content
FORM 'A'
[See rule 87 (6)]
Cash Memo
No. _____________
Date _____________
Name and address of the licensee _____________________________________________
No. of the licence in Form (F. L. XII) _____________
Name and address of the person to whom prescribed. _____________________________________________
Name and address of the person to whom delivered. _____________________________________________
Name and address of the Registered Medical practitioner by whom prescribed. _____________________________________________
| Foreign liquor prescribed | ||||
|---|---|---|---|---|
| Prescription No. (1) | Date (2) | Kind (3) | Quantity (4) | Amount received (5) |
| _______ | _______ | _______ | _______ | _______ |
| Rs. P. S. | ||||
| _______ | _______ | _______ | _______ | _______ |
Signature of the licensee or his authorised agent or servant.
_____________________________________________
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