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Insecticides Rules, 1971

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















* 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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