Employee no.

:29030 Name of Field person : Ravi Tiwari

HQ :Lucknow Task Force : Spectracare

Designation :MT Date : 30/9/2010

Doctor’s Name: Dr.P.K Saxena Spcl/ctg : GP(B)

MSL code : 0347448 patch no :07

Last two visits date: 30/9/2010

Address:
Dr.P.K Saxena
Kumar Clinic,
A-52, Narayan Nagar,
Faizabad Road,
Lucknow
9415162463
Requirment:
S.no. Product QUANTITY
1 NUTRAMIDE 30 TAB
2
3
4
5

Total support for your task force: 2000/-

Total support for Cipla : 8000/-

Requirement type monthly…………..……. Sos…(yes)……….

(Please write yes/no)

Signature of field person Ravi Tiwari

FOR OFFICE USE ONLY
DISPATCH DATE:…………………………….
INVOICE NO./DATE:…………………….
If dispatched through depot:

Courier:…………………….. CN No./date…………..

Any special comments by RM for more than 5 products or > Rs 500/- value.
P.S.: without MSL code/ visit dates of the doctor’s, your request cannot be approved