Page 414 of 1109
FORM D.S.XXII1[See rule 18(7)]
| D. S. I Licence No |
| Name of the Licensee .................. |
| Period of the Licence |
| Register of issues under bond (duty-free) and to Government liquors warehouses |
| Number and date of permit |
Amount authorised to be removed |
Strength authorised |
Destination |
Date when racked |
Number of cask |
| 1 |
2 |
3 |
4 |
5 |
6 |
|
| Weight of empty package |
Weight of full package |
Weight of spirit |
Temperature |
Indication |
Strength |
| 7 |
8 |
9 |
10 |
11 |
12 |
|
| Weight of spirit per litre |
Bulk litres |
Proof litres |
Vat from which drawn |
Date and hour when spirit removed |
Remarks |
| 13 |
14 |
15 |
16 |
17 |
18 |