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EXPENSES Country : _ Serial Nber :

APPROVAL REQUEST
Company : _ Date of EPR :
General Section
Project Code :

EXPENSES / PROJECT Information : Comments :

Type of Expenses or Project : _ If the type of the expenses is related to Meetings please
specify on the following:

Type of Meetings : _

1- Please complete and approve the Compliance Section before approving Compliance Section
the General Section
2- Once the project fully completed and delivered, the project leader or
the expense requester must complete and sign-off the follow-up section . Follow Up Section
Financial and Budgetting Informations:
Description Currency LC Amount USD Amount Cost Center Brand Activity Currency LC Amount USD Amount
_ _ 0,00 _ _ _ Requested
_ ,00 0,00
Amount
_ _ 0,00 _ _ _
Budget
_ 0,00
Amount
_ _ 0,00 _ _ _
Was this expense
_ _ 0,00 _ _ _ Yes No
budgetted ? :
_ _ 0,00 _ _ _
Expected delivery date :
_ _ 0,00 _ _ _

_ _ 0,00 _ _ _

_ _ 0,00 _ _ _

Approvals : Local site: North Africa (according to the DoA) : MENA / CEEMA (according to the DoA) :

Requester : _______________: _______________:

Date : Date : Date :

N+1 Requester : _______________: _______________:

Date : Date : Date :

Finance : _______________: _______________:

Date : Date : Date :

Country Manager : _______________: _______________:

Date : Date : Date :

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EXPENSES Country : _ Serial Nber :

APPROVAL REQUEST
Company : _ Date of EPR :
Compliance Section
Project Code :

Section 1 : _ Section 2 :Report in this section all the costs related to Donations, Sponsoring and Gifts

Theme or subject Location of the Meeting

List of Beneficiaries Name & Surname Explain the reason behind and why this Donation, Sponsoring or Gift is for ?
Planned Guests Attendees Report the Meeting costs in USD

Generalists BDGT ACT

Specialists Speaker Fees

Breakfast
Others
Lunch
TOTAL
Diner
If this Meeting hold a speaker then complete the following section :
Give a brief description of this Donation, Sponsoring or Gift.
Transport
Speaker Moderator
Name Housing

Speciality Other 1

Meeting Room
Service supplied
Miscelleneous

Other 2
Explain Why did
you choose the TOTAL BDGT ACT
speaker ?
Quantities

Unit Value

Value in USD

1- Courtesy gifts are limited to chocolate, candies, plants, flowers, tea or coffee.
2- Sponsoring and Don can not be granted to individuals
Requester Approver

The services are in accordance with the principles of PharmaCode Maghreb

The spending(expenses) is in Requester Approver
accordance with the principles
and with the limits defined by the
The meeting is in compliance with the limits defined by PharmaCode Maghreb Maghreb pharmacode

APPROVALS APPROVALS

Requester : Requester :
Date : Date :

MedicalManager : Medical Manager :

Date : Date :

Sales Manager : Sales Manager :

Date : Date :

Marketing Manager : Marketing Manager :

Date : Date:

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EXPENSES Country : _ Serial Nber :

APPROVAL REQUEST
Company : _ Date of EPR :
Follow Up Section
Project Code :

Purchase Orders Information : Invoices Information :

PO Date PO Nber Description Currency LC Amount USD Amount Inv Date Inv Nber Supplier Currency LC Amount USD Amount
_ _ _ 0,00 _ _ _ 0,00

_ _ _ 0,00 _ _ _ 0,00

_ _ _ 0,00 _ _ _ 0,00

_ _ _ 0,00 _ _ _ 0,00

_ _ _ 0,00 _ _ _ 0,00

_ _ _ 0,00 _ _ _ 0,00

_ _ _ 0,00 _ _ _ 0,00

_ _ _ 0,00 _ _ _ 0,00

_ _ _ 0,00 _ _ _ 0,00

_ _ _ 0,00 _ _ _ 0,00

_ _ _ 0,00 _ _ _ 0,00

_ _ _ 0,00 _ _ _ 0,00

_ _ _ 0,00 _ _ _ 0,00

_ _ _ 0,00 _ _ _ 0,00

_ _ _ 0,00 _ _ _ 0,00

_ _ _ 0,00 _ _ _ 0,00

_ _ _ 0,00 _ _ _ 0,00

_ _ _ 0,00 _ _ _ 0,00

_ _ _ 0,00 _ _ _ 0,00

_ _ _ 0,00 _ _ _ 0,00

Nber of TOTAL TOTAL Nber of TOTAL TOTAL

LC LC
POs LC Amount USD Amount Invoices LC Amount USD Amount
0 _ 0,00 0,00 0 _ 0,00 0,00

SIGN OFF SECTION :

I, the requester of these expenses, declare hereby, that I, fully and duly, have followed up the implementation and delivery of the present request. As well as declare that I have observed and
conducted all the works in accordance with the applicable diligences and AstraZeneca policies. This sign off is not intended to waive any responsabilities that could be raised following any
internal control or audit conducted either internally or externally. Name :_____________________________ Date : __________ Signature :_________________
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