Serial No ............................ |
CONSIGNMENT NOTE TO ACCOMPANY CHARGEABLE GOODS REMOVED FROM BREWERY |
Form 3 Regulation 10 |
(1) | (2) | (3) | (4) | (5) | (6) | (7) | (8) | (9) | (10) | (11) | (12) |
Date of Delivery | Name & Address of Brewer | Marks & Nos. (if and) on containers | Quantity & Description of goods | Name of person in-charge of Conv- eyance | Name & Address of person to whom goods are delivered | Name & Address of buyer if different from person in Column (6) | Total net price payable exclusive of Cons. Tax | Quantity on which tax is payable | Rate of Duty | Amount of C. Tax payable | Marks |
| | | | | | | | | | | |
Certified as above, sent from ................................................... |
this ........................... day of .................................. 20 ............. | ........................................................... |
| Brewer |
N.B. This consignment Note is to be used for chargeable goods removed from the premises of the Licensed Brewer, and unless the goods are accompanied by such Consignment Note or other document authorised by the Comptroller they will be liable to seizure. Any person who alters this note with a view to the fraudulent evasion of Consumption Tax is liable to a penalty of $1,000. |
Form 4 Regulation 11 |
ACCOUNT OF MATERIALS USED AND WORTS COLLECTED |
Name of Brewer .......................................................................... |
Address of Brewer ...................................................................... |
Month of ............................ 20......... | ..................................................................................................... |
Materials Used | Quantity Received | If imported Entry No. and Date | Date | Quantity Used | Balance | Date of | Worts Collected |
Brewing | Collection | Name & Nos. of vessel | Bulk gallons |
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Unamalted Corn | | | | | | | | | |
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Rice, Rice grits, Maize grits and other similar preps. | | | | | | | | | |
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Sugar including its equivalent of glucose and syrup | | | | | | | | | |
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