FORM R.S. DI

[See rule 18]

Requisition for rectified or absolute alcohol

Part I

(To be kept with the Inspector of Prohibition and Excise countersigning the requisition.)

Place ........................... Date ..........................

Messrs

Warehouse

The Officer,

Distillery

Sir(s),

Please supply me/us with [litres/bottles of* millilitres each] of rectified spirit/absolute alcohol for Purposes.

The number of my rectified spirit Sale licence ¹possession licence/bottling licence¹ issued by the Collector of is

Yours faithfully,

Signature of the purchaser.

Countersigned.

Inspector of Prohibition and Excise Date No

Seal of the Officer Countersigning The requisition.

Part II handed over to the licensee on .

Part III sent to the supplying licensee, warehouse officer or distillery officer on

Part IV sent to the Inspector of Prohibition and Excise in whose charge the Licensed premises of the person holding a sale licence, warehouse or distillery is situated on

Intimation of the supply received on ......................................................

Verified with the Licensee's accounts on .....................................

Signature of the Inspector of Prohibition and Excise.