[See rule 6 (h)] Name of the firm (Licensee)................. For the month of................ 1. Serial Number (in the register) 1. Serial Number (In the register) 2. Description of object with a photograph. 2. Description of object with a photograph. *3. Address of person to whom sold 3. Address of person from whom acquired. Seal of Organization **Signature of licensee Date Place * The nationality of foreigners to whom an antiquity is sold together with their address in India and at home ard passport number should be recorded. ** In the case of a firm, the signature of the head of the organization.
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