| Quantity issued under bond | Number of bottles | Remarks |
|---|---|---|
| Litres | 750 ml. | 375 ml. |
| (46) | (47) | (48) |
| 180 ml. | - | - |
| (49) | (50) | (51) |
| (52) (53) | ||
Here mention the bottles or vessels of any other capacity allowed by the Director to be filled in.
I/We declare that the particulars in this statement have been correctly stated.
(Signature of the licensee or his authorised agent)
Countersigned and forwarded to the Superintendent/District Inspector of Prohibition and Excise
Manufactory Officer.