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. Roshan Pokharel

b. Mailing Address & Head, Dept of Psychiatry, and Medical
Superintendent, Koshi Zonal Hospital,
Biratnagar
Phone Number of Doctor 9852024180
c. His/Her Specialty Psychiatrist
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 500,000/ month.
g. Present support monthly in rupee 200,000/month.
value & Name of products a Oleanz, nexito, encorate, zosert, sizodon,
duzela, arpizol, sulpitac, dicorate, veniz xr,
lobazam, oxetol, prodep, pramipex, gabantin,
lonazep, maxgalin, mirtaz

h. Expected support monthly in rupee 250,000/month.

Value & Name of product after
SAS/Local Conference
i. Doctor’s Nl. In SAS List
Oleanz, nexito, encorate, zosert, sizodon,
duzela, admenta, sulpitac, dicorate, veniz xr,
lobazam, oxetol, prodep, pramipex, gabantin,
lonazep, maxgalin, mirtaz, levipil, rivamer
SAS.
Sc code: 324834

3) a. Provide all details of SAS/LC Saturday Satellite clinic once a month

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 Bills
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.: