FORM C. L. XXI—contd.
The following quantity against the above indent has been issued under Transport Pass No. ................ ..............................................dated the
| Serial No. |
Variety of country liquor |
No. of bottles and other receptacles | |||||||
|---|---|---|---|---|---|---|---|---|---|
| (1) | (2) | Strength (3) |
750 ml. (4) |
375 ml. (5) |
180 ml. (6) |
200 B.L. (7) |
1♦1 B.L. (8) |
1♦1 B.L. (9) |
|
| Total No. | |||||||||
| Quantity in Bulk Litres | |||||||||
Dated ............ ........... ..... Signature of the Wholesale Licensee or his Authorised Agent.
1Here mention the bottles or receptacles of any other capacity allowed to be filled in by the Commissioner.1
Note —
- Original of this is to kept by the indenting licensee.
- Duplicate and Triplicate to be sent to Wholesale Licensee.
- The Wholesale licensee to fill in both the copies and return duplicate to the Retail Sale Shop Licensee and retain Triplicate on his record.