FORM D.S. XXXO
(See condition 10 of Form D. S. IV)
D. S. IV Licence No. ........................
Name and Address of the Licensee
Period of the Licence ................................
Register of accounts of Denatured Spirit used for bona fide Medical, Scientific and Educational purposes during the month .......................... 19 ..
| Date (1) |
Opening balance (2) |
Quantity of Denatured Spirit purchased (3) |
Source of Supply (4) |
Total of Columns (2) and (3) (5) |
Quantity used (6) |
|---|---|---|---|---|---|
| Litres/Bottles | |||||
| Purpose for which used (7) |
Closing balance [column (5) minus column (6)] (8) |
Remarks, if any, and initials of the licensee (9) |
|---|---|---|
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