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SAS RECOMMENDATION FORM - 2017-18.

DIVISION: MILMET

REGION DETAILS DOCTOR DETAILS

REGION: BENGALURU Dr. Name: DR SRINIVAS RAO K

Name of SO : H.Q.: Speciality : MSO SC CODE


SRUTHESH KUMAR BENGALURU

Name of FLM : H.Q.: Locality : BANGLORE 1249066


LOKESH N BENGALURU

Name of SLM : DHANANJAYA.L H.Q.: BENGALURU Locality Covered as Ex-Stn / Out-Stn /HQ : HQ

Name of TLM : H.Q.: CHENNAI Address : EYE FOUNDATION

Phone No.: 9900057706


TERRITORY PERFORMANCE Email ID: seandsilva@eyefoundation,com
CURRENT YEAR YTD LAST YEAR YTD
ACH% GR% PMPM INCR. PMPM ACH% GR% PMPM INCR. PMPM

VISIT DETAILS BUSINESS DETAILS (Rs. In Lacs / Month)


Put actual visit date of Last 3 months Business Potential (Milmet) 20000
Month ----> june jujy aug Current Support 14000
Expected Business 20000
SO 4,25 10,18,30 6,13,20
Average Current Business of Last 3 months Next 6 months Avg Exp.
Product Name Amount Buss.
FLM 18
1 TEAR DROPS 3000.00 3000.00
2 MILFLOX 3000.00 4000.00
SLM 10,30
3 MILFLODEX 4000.00 6000.00
4 TEARDROP GEL 4000.00 6000.00
TLM
5
6 Others
SAS DESCRIPTION / REMARKS TOTAL 14000.00 20000.00

PAYMENT / REIMBURSEMENT DETAILS


Cheque Name / Beneficiary's Name Amount Payable at

1
AMOUNT FOR APPROVAL
2

Discount Counter Approval (Yes / No) NO TOTAL


If % Discount
Yes Last 6 Month's Avg Counter Sales 15K Beneficiary's PAN
(if payment is to be made in the name of Party
Current Year Previous SAS details for the same Dr. if any
Sr. No. Amount Month Activity Description BUDGET PROVISIONS (Rs. In Lacs)
1 NO Description Area Region Zone
2
Total Allocated Budget
3
Total
SAS expense till date
Current year Total SAS amount for this Territory. (Rs.)
% to Sales
Balance Budget

Last Year SAS details for the same Dr. if any Expense Recommended or
Sr. No. Amount Month Activity Description approved for this SAS
1
Balance amount C/F.
2
3
Total
Last year Total SAS amount for this Territory. (Rs.)
% to Sales
Signed / Approved by:-

FLM SLM TLM NSM/DGM SBU Head Cluster Head


Date: Date: Date: Date: Date: Date:

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