FORM NO. N-IV/R

[See rule 15(1)]

Register of Neera drawn and supplied from the Neera Supply Centre No. _____ at _____ in the Taluku _____ in the District _____ during the month _____ 19_____

NAME OF THE N-IV LICENSEE

Quantity of Neera drawn

Quantity of Neera supplied to persons holding licence for

Date

Total No. of trees tapped

ml.

Retail sale

Manufacturing

Quantity of Neera destroyed

ml.

(1)

(2)

(3)

(4)

Articles manufactured from Neera—						Signature of the Licensee or his Authorised Servant
Quantity of Neera used for manufacture of Gur and other articles	Rab	Gur	Sugar	Sweets	(Sugar syrup)	Signature of the Licensee or his Authorised Servant
ml.	Kg. g.	Kg. g.	Kg. g.	Kg. g.
(5)	(6)	(7)

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