FORM No-N-IV/NR
[See rule 15(2)]
Register of the Neera Retail Sale Licence holders and Gur manufacturing Licence holder to whom Neera is supplied from supply Centre in the Taluka of ........................... in the District of ............................
| NAME OF N-IV LICENSEE | ||||
|---|---|---|---|---|
| Neera supplied | ||||
| (1) | (2) | (3) | (4) | (5) |
| Date | Name of the persons holding a neera retail sale licence and name of the retail sale centre | Name and address of the person holding a licence to manufacture Gur and other articles from neera Quantity 1 ml. Pass No. |
Signature of the Licensee or his Authorised Servant Quantity 1 ml. Pass No. |
Signature of the Licensee or his Authorised Servant |
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