| Quantity issued under bond | Details | ||||
|---|---|---|---|---|---|
| Duty paid during the month (14) | Transport fee paid during the month (15) | Bulk litres (16) | Number of each kind of bottles/casks/kegs (17) | Contents in each kind of bottles/casks/kegs L/ml. (18) | |
| Total Quantity issued during the month | Closing balance at the end of the month | Remarks | |||||
|---|---|---|---|---|---|---|---|
| Bulk liters (19) | Number of each kind of bottles/casks/kegs (20) | Contents in each kind of bottles/casks/kegs L/ml. (21) | Bulk liters (22) | Number of each kind of bottles/casks/kegs (23) | Contents in each kind of bottles/casks/kegs L/ml. (24) | (25) | |
I/We declare that the particulars in this statement have been correctly stated.
Countersigned and forwarded to the Superintendent / District Prohibition and Excise Officer
Brewery / Manufactory Officer.
(Signature of the licensee or his authorised agent)