FORM R.S. in

[See rule 18]

Requisition for rectified spirit or absolute alcohol

Part II

(To be handed over to the applicant and to be kept by him with the passes.)

Place

Messrs

The Warehouse Officer,

Distillery

Sir(s),

Please supply me/us with ¹litres/bottles of* milliliters each¹ of rectified spirit / absolute alcohol for .................................. Purposes.

The number of my rectified spirit sale licence issued by

¹possession licence/bottling licence.¹

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.

Rectified spirit/absolute alcohol supplied on

Signature of the person holding a sale licence or

of The Warehouse officer,

Distillery