FORM R.S. H-B

[See rule 15(b)]

R.S.II licence No ................

Name of the licensee

Period of the licence .

Monthly return showing rectified spirit (including absolute alcohol) received used and held in balance during the month of............................................ 20.

Opening balance on the first day of the month			Quantity purchased
Month	Litres/Bottles of 750 ml. each	Bottles of 500 ml. each	Bottles of 250ml. each	Litres/Botlles of 750 ml.	Bottles of 500ml. each	Bottles of 250ml. each
1	2	3

Transport pass Totals of columns 2 and 3

Source of supply	No.	Date	Litres/Bottles of 750 ml. each	Bottles of 500 ml. each	Bottles of 250 ml. each
4	5	6

Quantity used			Closing balance on the last day of the month
Litres/Bottles of 750 ml. each	Bottles of 500 ml. each	Bottles of 250 ml. each	Litres/Boltles of 750 ml.	Bottles of 500 ml.	Bottles of 250 ml.
7	8	9

Signature of the licensee].

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