FORM C.L.X contd.
| Transport Pass No. | Name of the Party to whom issued | Chalan No. and date | Amount of duty paid | Batch No. |
|---|---|---|---|---|
| (18) | (19) | (20) | (21) | (22) |
Quantity of Country Liquor issued from Store Room
Number of bottles and other receptacles
| 750 ml. bottles | 375 ml. | 180 ml. | Total Quantiy in B.L., | 200 B.L. | * | Quantity in other receptacles |
|---|---|---|---|---|---|---|
| (23) | (24) | (25) | (26) | (27) | (28) | (29) |
Quantity of Country Liquor held in balance
Number of bottles and other receptacles
| 750 ml. | 375 ml. | 180 ml. | Total Quantity in bottles | 200 B.L. | B.L., |
|---|---|---|---|---|---|
| (30) | (31) | (32) | (33) | (34) | (35) |
| Total Quantity in other receptacles | Signature of Licensee | Manufactory Officer | Remark |
|---|---|---|---|
| (36) | (37) | (38) | (39) |
Here mention the receptacles of any other capacity allowed to be filled in by the Commissioner
Y-373-69