FORM D. S. XXXIII
[See condition 10 of Form D. S. IV]
D. S. IV Licence No
Name and Address of the Licensee
Period of the Licence ..................................
Monthly return for the month ...............................19 .
| Opening balance on the first day of the month | Quantity of Denatured Spirit purchased | Total of columns (1) and (2) | Quantity used on the last day of the month | Closing balance | Remarks, if any. |
|---|---|---|---|---|---|
| (1) | (2) | (3) | (4) | (5) | (6) |
| Litres/Bottles | Litres/Bottles | Litres/Bottles | Litres/Bottles | Litres/Bottles |
Date
Signature of the Licensee.
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