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SAS/LC RECOMMENDATION FORM

DIVISION:Sun Div.

1) a. Name of Associate Vice President Mr. Prashant Sagare H.Q. Mumbai


b. Name of Deputy General Manager Mr. B. K. Shrestha H.Q. Kathmandu
c. Name of FLM Mr. K.Nag.Roy. H.Q. Biratnagar.
Dinesh Poudyal, Sanjay
Kumar, Bhuwan Niroula, Biratnagar,D
d Name of PSR/FSO H.Q.
Biplaw Bhattarai, Homnath haran.
Shrestha

2) a. Name of the Doctor Dr. Mohan Chandra Regmi


b. Mailing Address & Consultant Gynaecologist, Dept. of Gynaecology,
B.P. Koirala Institute of Health & Sciences,
Dharan, Nepal.
Phone Number of Doctor 9779852049414
c. His/Her Specialty Gynaecologist
d. Type of Practice VIP/A/B A
e. Nature of Practice Hospital.
(Private/Hospital)
Full/Part Time Full Time.
f. Potential for our product mix 30,000/ month.
g. Present support monthly in rupee 15,000/month.
value & Name of products a Susten, Nexito, Caberlin

h. Expected support monthly in rupee 20,000/month.


Value & Name of product after Susten, Nexito, Caberlin, Pantocid, Amlosun,
Aquazide, Eliwel
SAS/Local Conference SAS.
i. Doctor’s Nl. In SAS List Sc code: 410815

3) a. Provide all details of SAS/LC Provide book ''Ostergard's Urogynecology and


Pelvic Floor Dysfunction''
Activities to be done
b. DD/Cheque in favour of
Amount
Payable at
c. DD/Cheque to be mailed
Place
d. Appeal letter is enclosed Yes/No Yes
e. What supporting/Receipt will be Bill
Sent by you?
f. Any other details

The SAS/LC recommendation is in accordance with SAS/LC Norms.

Signature of Signature of Signature of


First Line Manager Mkt Manager SBU

Date: 15/08/11 Date: Date:


Details of Enclosure:
P.S. Please route all your SAS/LC requests through your S.M.
Territory Area Region Zone
Total Budget
Allocated
SAS/LC Expense
till date

Balance Budget
Expense
Recommended for
this SAS/LC
Balance amount
C/F.: