FORM C.L. XXn-A

[See Rule 33(a) and condition 5(a) of licence in Form CL-II]

Name of Licence:	Month:	Year:
Kind of Licence and Number:			Date:

Name of the Brands	Opening Balance 1000:500: 750 650: 375: 330: 325: 180: 60 ml ml ml ml ml ml ml ml								Receipt 1000:500: 750 650: 375: 330: 325: 180: 60 ml ml ml ml ml ml ml ml								Sale 1000: 500:750 650: 375: 330: 325: 180: 60 ml ml ml ml ml ml ml ml								Closing Balance 1000: 500: 750 650: 375: 330: 325: 180: 60 ml ml ml ml ml ml ml ml
(1)	(2)	(3)	(4)

ml = Millilitre

¹Inserted by 31-8-2001¹

Y-373-72