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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 FLS Mr. K.Nag.Roy. H.Q. Biratnagar.
Dinesh Poudyal, Sanjay
Kumar, Bhuwan Niroula, Biratnagra,D
d Name of PSR/FSO H.Q.
Biplaw Bhattarai, Homnath haran.
Shrestha

2) a. Name of the Doctor Dr. Prashant Shah


b. Mailing Address & Senior Resident, Dept of Medicine, BPKIHS
Phone Number of Doctor
c. His/Her Specialty Cardiologist
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 100,000/ month.
g. Present support monthly in rupee 30,000/month.
value & Name of products a Aztor, clopilet, repace, rozavel, prolomet xl,
maxgalin, pantocid, amlosun, irovel, montek

h. Expected support monthly in rupee 40,000/month.


Value & Name of product after Aztor, clopilet, repace, rozavel, prolomet xl,
maxgalin, pantocid, amlosun, irovel, montek,
glucored forte, dazolic, aztor ez, panlipase,
levipil
SAS/Local Conference SAS.
i. Doctor’s Nl. In SAS List Sc code: 360950

3) a. Provide all details of SAS/LC Sample of Repace H = 30 tab per month for 12
months
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
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.:

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