FORM XIV
MONTHLY RETURN OF SALES OF INSECTICIDES MADE TO THE BULK
CONSUMERS OF THE STATE OF ___________________ FOR THE PERIOD FROM _____________ TO
_________20_________
[Rule 15]
Sl. No. |
Name of the insecticides with its brand name
strength and type of formulation |
Manufactured by |
Batch No. |
Date of expiry |
Name of the purchaser with full address |
Licence No. of purchaser |
Size of pack |
No of packs sold |
Qty. |
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* In case of bulk consumer give number and date of the order.
Signature_______________
Verification
I ____________________________do hereby verify that what is stated above is true to the
best of my knowledge and belief based on information derived from the records. I further
declare that I am competent to and verify this statement in my capacity as _________
(designation)
Signature__________________
Name____________________
Seal_____________________
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