FORM D. S. XXXIII

Bombay Prohibition Act, 1949 [1949 : Bom. XXV FORM D. S. XXXIII [See condition 10 of Form D. S. IV] D. S. IV Licence No. ................................. Name and Address of the Licensee......... Period of the Licence .................................. Monthly return for the month of ............................... 19 . —————————————————————————————————————————— Opening balance on Quantity of Total of Quantity used C losing balance Remarks, the first day of the Denatured Spirit columns (1) and on the last day of if any, month purchased (2) the month (1) (2) (3) (4) (5) (6) —————————————————————————————————————————— Litres/Bottles Litres/Bottles Litres/Bottles Litres/Bottles Litres/Bottles —————————————————————————————————————————— Date ................................. Signature of the Licensee.