NBM REQUEST FORM FOR DOCTORS REQUIREMENT
Without MSL code/visit dates of the doctor, your request cannot be approved.
Employee no. Designation HQ MSL code Doctors name
: :
55193 TM
Name of field person : HARISH KUMAR.M Date:21/03/2012 Task Force :SPECTRACARE 2 Patch no : 10 Spcl/Ctg : physician
: MYSORE : 0632940 : UDAYA KUMAR
Last two visits date: 28/2/2012 Current Business : 300 Expected Business: 3000 Address : NO CH 11 2 ND MAIN 5TH CROSS SARASWATHIPURAM MYSORE 570009 Mobile / Telephone no of Dr: - 9448602311 Product Requirement SL.NO PRODUCT 1. 2 TELMSNATIN 40 ROSVASTULIN
QUANTITY 30 30
Requirement type: (Please write Yes/No) B. M .Name :
Monthly:
SOS:
B.M APPROVAL: Comments by BM: -
RETAILING SHEET
Dr Name: UDAYAKUMAR SPL: PHY PRODUCTS (team-II) NOVAMOX CV QUANTITY 5 SHEETS VALUE 300 PRODUCTS (team I) CAT: A+ DATE: 21/03/2012 QUANTITY VALUE
TOTAL Note:
300
TOTAL
Do not send NBM directly to Depot through BM it as to come mail u r Respective BMs and more then 500/- costing NBM send retailing sheet To depot with in 5th of every month for furture continuing.