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 |
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