*[FORM CLXDI
[See rule 7 (1)]
(lb be kept on Wholesale Licensee's record)
Indentfar the supply ofCountry Liquor
Wholesale Licence No Indent No. ....................
Date
The Manufectory Licensee of Country Liquor
Sir;
Please supply Bulk litres ofcountry liquor in the following receptacles:
| Strength of Country Liquor |
Variety | No of casks or Kegs of the capacity of 200 B.L. 100 B.L. 50 B.L. |
No of bottles of the capacity of 750 ml. |
375 ml. | 180 ml. |
|---|---|---|---|---|---|
| (0 | (2) | (3) | (4) |
Total No...
Quantity in Bulk Litres..
Signature of the Wholesale Licensee or his
authorised agent.
Quantity issued under Transport Pass No.
dated
Manu&ctory Officer
Dated
Submitted to the Manufactory Officer.
Endorsement of the Manufactory Licensee.
1 Subs, by G N. 20-6-1977.