Record of

Here insert the name of the drug to which the record relates.

sold or supplied.

THE HONG KONG GOVERNMENT GAZETTE, DECEMBER 13, 1935.

Form in which

sold or

supplied.

When sale is on

a prescription, specify the ingredients

of the

prescription.

Amount sold

or supplied.

Date on which the transaction

was effected.

Name of person, body or firm to whom sold or

supplied.

Address of person, body or firm to whom

sold or

supplied.

Authority of person, body or firm to be in possession of the drug.

1201

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