FORM R.S. H-A
1[See rule 15(b)]
R.S.II licence No
Name of the licensee ......... . .
Period of the licence
Statement of Accounts showing rectified spirit (including absolute alcohol) received used and held in balance during the month of............................................ 20.
| Opening balance | Quantity received | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Date | Litres/Bottles of 750 ml. each | Bottles of 500 ml. each | Bottles of 250ml. each | Litres/Bottles of 750 ml. each | Bottles of 500 ml. each | Bottles of 250ml. each | |||||
| 1 | 2 | 3 | |||||||||
| Transport pass No. | Date | Totals of columns 2 and 3 | ||
|---|---|---|---|---|
| Source of supply | Litres/Bottles of 750 ml. each | Bottles of 500 ml. each | Bottles of 250 ml each | |
| 4 | 5 | 6 | ||
| Quantity used | Closing balance | Remarks, if any and initials of the licensee | ||||
|---|---|---|---|---|---|---|
| Litres/Bottles of 750 ml. each | Bottles of 500 ml. each | Bottles of 250 ml. each | Litres/Bottles of 750 ml. each | Bottles of 500 ml. each | Bottles of 250 ml. each | |
| 7 | 8 | 9 | ||||
1[Ins. by GN. of 26-9-1966]
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