Claims TopSheet Print Page 1 of 5

To, From:
Hindustan Coca-Cola Beverages Pvt. Ltd., Distributor ID: GC01396231
Bangalore Beverage Distributor Name: CHATHURTHEE SALES (BHARATH)
Address: NO 46B PLOT NO 2 GUTTAL ROAD, YATTINAHALLI, HAVERI,
HAVERI, HAVERI, KARNATAKA, PIN - 581110
Kind Attn: Rudresh HR
Bucket Period: 13/11/2021 - 26/11/2021 Claim No.: 22 - 2021 (Other Expense TopSheet)
MER No. Scheme Period Scheme Remarks Sales Qty Free Qty Rate Amount
14654322 (FXA) 24/11/2021 - 24/11/2021 Distributor Support from 28.10.2021 to 23.11.2021, On ALL Discount of FXA
ALL
14655037 (FXA) 25/11/2021 - 25/11/2021 28.10.2021 to 24.11.2021 L&B Support0.25%GRNov21, On ALL Discount of FXA
ALL

Grand Total

Request the company to do the price adjustment as agreed at the time of purchase
I certify the following:
1) All claims are submitted with proper & original supportings.
2) Summary for each scheme as above is separately attached herewith.
3) I understand that the above claims shall be credited to my account only post scrutiny and necessary approvals and that submission of
above claim amount does not guarantee total clearance of the same.
4) Sales tax laws as applicable may be complied with as per policies of the company.
5) That all claims for the aforesaid period have been submitted and no further claims shall be raised for the said period again.
(For Office Use)
For, SE Approval
CHATHURTHEE SALES
ASM Approval

Sign. & Stamp SM Approval

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Claims TopSheet Print Page 2 of 5

To, From:
Hindustan Coca-Cola Beverages Pvt. Ltd., Distributor ID: G000217069
Bangalore Beverage Distributor Name: RAMSONS ASSOCIATES - MUNDGOD ()
Address: 55 NETAJI NAGAR, MUNGOD, MUNDGOD,
MUNDGOD, UTTARA KANNADA, KARNATAKA, PIN - 581349
Kind Attn: Prashant Naik
Bucket Period: 13/11/2021 - 26/11/2021 Claim No.: 22 - 2021 (Other Expense TopSheet)
MER No. Scheme Period Scheme Remarks Sales Qty Free Qty Rate Amount
14655035 (FXA) 25/11/2021 - 25/11/2021 28.10.2021 to 24.11.2021 L&B Support0.25%GRNov21, On ALL Discount of FXA
ALL

Grand Total

Request the company to do the price adjustment as agreed at the time of purchase
I certify the following:
1) All claims are submitted with proper & original supportings.
2) Summary for each scheme as above is separately attached herewith.
3) I understand that the above claims shall be credited to my account only post scrutiny and necessary approvals and that submission of
above claim amount does not guarantee total clearance of the same.
4) Sales tax laws as applicable may be complied with as per policies of the company.
5) That all claims for the aforesaid period have been submitted and no further claims shall be raised for the said period again.
(For Office Use)
For, SE Approval
RAMSONS ASSOCIATES - MUNDGOD
ASM Approval

Sign. & Stamp SM Approval

http://appsportal.hccbpl.in/CokeOneLive/Discounts/Transactions/Claims_TopSheet_Print... 27-11-2021
Claims TopSheet Print Page 3 of 5

To, From:
Hindustan Coca-Cola Beverages Pvt. Ltd., Distributor ID: GC04402961
Bangalore Beverage Distributor Name: AAROODHA ENTERPRISES (SHRISHAIL C PATIL)
Address: PLOT NO 56A TIMBER YARD, UNIKAL HUBLI, CIRCLE II HDMC,
HUBLI DHAR, DHARWAD, KARNATAKA, PIN - 580031
Kind Attn: Prashantkumar Math
Bucket Period: 13/11/2021 - 26/11/2021 Claim No.: 22 - 2021 (Other Expense TopSheet)
MER No. Scheme Period Scheme Remarks Sales Qty Free Qty Rate Amount
14652147 (FXA) 17/11/2021 - 17/11/2021 OCT21 MEPD CSD&JUICE, On ALL Discount of FXA
ALL
14652188 (FXA) 18/11/2021 - 18/11/2021 OCT21 MEPD WATER, On ALL Discount of FXA
ALL
14654323 (FXA) 24/11/2021 - 24/11/2021 Distributor Support from 28.10.2021 to 23.11.2021, On ALL Discount of FXA
ALL
14655036 (FXA) 25/11/2021 - 25/11/2021 28.10.2021 to 24.11.2021 L&B Support0.25%GRNov21, On ALL Discount of FXA
ALL

Grand Total

Request the company to do the price adjustment as agreed at the time of purchase
I certify the following:
1) All claims are submitted with proper & original supportings.
2) Summary for each scheme as above is separately attached herewith.
3) I understand that the above claims shall be credited to my account only post scrutiny and necessary approvals and that submission of
above claim amount does not guarantee total clearance of the same.
4) Sales tax laws as applicable may be complied with as per policies of the company.
5) That all claims for the aforesaid period have been submitted and no further claims shall be raised for the said period again.
(For Office Use)
For, SE Approval
AAROODHA ENTERPRISES
ASM Approval

Sign. & Stamp SM Approval

http://appsportal.hccbpl.in/CokeOneLive/Discounts/Transactions/Claims_TopSheet_Print... 27-11-2021
Claims TopSheet Print Page 4 of 5

To, From:
Hindustan Coca-Cola Beverages Pvt.
Distributor ID: GC01700087
Ltd.,
Bangalore Beverage Distributor Name: M K ENTERPRISES (MOHAMMED YUSUF)
Address: KHAIRATI TABIB LAND, KULKARNI HAKKAL, HUBBALLI CIRCLE HDMC
KARNATAKA,
HUBLI DHAR, DHARWAD, KARNATAKA, PIN - 580020
Kind Attn: Prashantkumar Math
Bucket Period: 13/11/2021 - 26/11/2021 Claim No.: 22 - 2021 (Other Expense TopSheet)
MER No. Scheme Period Scheme Remarks Sales Qty Free Qty Rate Amount
14654321 (FXA) 24/11/2021 - 24/11/2021 Distributor Support from 28.10.2021 to 23.11.2021, On ALL Discount of FXA
ALL
14655039 (FXA) 25/11/2021 - 25/11/2021 28.10.2021 to 24.11.2021 L&B Support0.25%GRNov21, On ALL Discount of FXA
ALL

Grand Total

Request the company to do the price adjustment as agreed at the time of purchase
I certify the following:
1) All claims are submitted with proper & original supportings.
2) Summary for each scheme as above is separately attached herewith.
3) I understand that the above claims shall be credited to my account only post scrutiny and necessary approvals and that submission of
above claim amount does not guarantee total clearance of the same.
4) Sales tax laws as applicable may be complied with as per policies of the company.
5) That all claims for the aforesaid period have been submitted and no further claims shall be raised for the said period again.
(For Office Use)
For, SE Approval
M K ENTERPRISES
ASM Approval

Sign. & Stamp SM Approval

http://appsportal.hccbpl.in/CokeOneLive/Discounts/Transactions/Claims_TopSheet_Print... 27-11-2021
Claims TopSheet Print Page 5 of 5

To, From:
Hindustan Coca-Cola Beverages Pvt. Ltd., Distributor ID: GC01699845
Bangalore Beverage Distributor Name: VINSUN ENTERPRISES (VISHAL R)
Address: NO RAJUR SAJJANUR COMPLEX, DAKAPPA CIRCLE, HUBALLI,
HUBLI DHAR, DHARWAD, KARNATAKA, PIN - 580020
Kind Attn: Mohammed Ibrahim Siddique
Bucket Period: 13/11/2021 - 26/11/2021 Claim No.: 22 - 2021 (Other Expense TopSheet)
MER No. Scheme Period Scheme Remarks Sales Qty Free Qty Rate Amount
14652187 (FXA) 18/11/2021 - 18/11/2021 OCT21 MEPD WATER, On ALL Discount of FXA
ALL
14654320 (FXA) 24/11/2021 - 24/11/2021 Distributor Support from 28.10.2021 to 23.11.2021, On ALL Discount of FXA
ALL
14655038 (FXA) 25/11/2021 - 25/11/2021 28.10.2021 to 24.11.2021 L&B Support0.25%GRNov21, On ALL Discount of FXA
ALL

Grand Total

Request the company to do the price adjustment as agreed at the time of purchase
I certify the following:
1) All claims are submitted with proper & original supportings.
2) Summary for each scheme as above is separately attached herewith.
3) I understand that the above claims shall be credited to my account only post scrutiny and necessary approvals and that submission of
above claim amount does not guarantee total clearance of the same.
4) Sales tax laws as applicable may be complied with as per policies of the company.
5) That all claims for the aforesaid period have been submitted and no further claims shall be raised for the said period again.
(For Office Use)
For, SE Approval
VINSUN ENTERPRISES
ASM Approval

Sign. & Stamp SM Approval

http://appsportal.hccbpl.in/CokeOneLive/Discounts/Transactions/Claims_TopSheet_Print... 27-11-2021