| Quantity sold to | D.S.R 2 Licence (9) | D.S.R 3 Licensee (10) | Other persons (11) | Quantity exported (12) | ||||
|---|---|---|---|---|---|---|---|---|
| Litres | Bottles | Litres | Bottles | Litres | Bottles | Litres | Bottles | |
| Total of columns 9 to 12 (13) | Closing Balance (14) | Remarks (15) | |
|---|---|---|---|
| Litres / Bottles | Litres | Bottles | |
*Not applicable to retail licensee
Name of the denatured spirituous preparation.................................. Form of licence
Licence No. .......................................___ _
Name and address of the licensee .... .............__ ....
| Name and address of the person to whom denatured spirituous preparation is sold and the number of his licence, if any | Quanitty sold | Signature of the licensee or his authorised nokar | Remarks | ||||
|---|---|---|---|---|---|---|---|
| Date (1) | Name (2) | Address (3) | No of licence, if any (4) | Litres (5) | Boules | ||
| Day,s total sales | |||||||
1 Deleted and renumbered by G N. of 2.2.1966.
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