SOS REQUIREMENT

Name of the field person HQ: Task Forse: Mob No:

raising request
MSL CODE Name of the Dr. with TELEPHONE Speciality Category TOTAL Samples required with strength
Complete postel Residential NUMBER Support Qty. in Tab / Cap
Address with pin code To Cipla

Signature

Date
 MONTHLY REQUIREMENT

Name of the field person HQ: Task Forse: Mob No:

raising request
MSL CODE Name of the Dr. with TELEPHONE Speciality Category TOTAL Samples required with strength
Complete postel Residential NUMBER Support Qty. in Tab / Cap
Address with pin code To Cipla

Signature:

Date:

* Remarks: Kindly take approval from your RM before sending Monthly Requirement to Regional office.
RM's Signature:
 Weekly Routine Expense / Work Detail Statement Page 3
Emp No 96883 Name: Harit deewan Head Quarter: gurgaon Desgition:
From 1/10/2013 TO: 31-10-2013 Tel./Mob.No.:
Places of Travel Dsecription of Local Telephone calls
Local
Total Tele Travel / Non- Description of
H.Q. or Tel.Exp.Amt.
Date STD Exp. Expenses Routine Exp. Travel / Other
From To OS (For Dm + O/S Name of the person SPL No. of calls made (Local+Std) Amt Expences
ME)

gurgaon gurgaon
1

2
holiday holiday
`

gurgaon gurgaon
3

gurgaon gurgaon
4

gurgaon gurgaon
5

sunday sunday
6

gurgaon gurgaon
7

8
gurgaon gurgaon

Note: Kindly Fill Work Details for all the days (1) On any day, if you have not incurred any expences then also just mention the work place / travels details / leave (2) incase you
are not worked on any particular day like sunday or holiday, then just mention as Sunday or Holiday
 Weekly Routine Expense / Work Detail Statement Page 4
Emp No: 96883 Name: Harit deewan Head Quarter: gurgaon Desgition:
Month: oct From 1/10/2013 TO: 31-10-2013 Tel./Mob.No.:
Places of Travel Dsecription of Local Telephone calls
Local
Total Tele Travel / Non- Description of
H.Q. or Tel.Exp.Amt.
Date STD Exp. Expenses Routine Exp. Travel / Other
From To OS (For Dm + O/S Name of the person SPL No. of calls made (Local+Std) Amt Expences
ME)

gurgaon gurgaon
9

gurgaon gurgaon
10

Sunday Sunday
11

gurgaon gurgaon
12

sunday sunday
13

gurgaon gurgaon
14

15
gurgaon gurgaon

gurgaon gurgaon
16

Note: Kindly Fill Work Details for all the days (1) On any day, if you have not incurred any expences then also just mention the work place / travels details / leave (2) incase you
are not worked on any particular day like sunday or holiday, then just mention as Sunday or Holiday
 Weekly Routine Expense / Work Detail Statement Page 5
Emp No: 96883 Name: Harit deewan Head Quarter: gurgaon Desgition:
Month: oct From 1/10/2013 TO: 31-10-2013 Tel./Mob.No.:
Places of Travel Dsecription of Local Telephone calls
Local
Description of
H.Q. or Tel.Exp.Amt.
Date Travel / Other
From To OS (For Dm + O/S Name of the person SPL No. of calls made Expences
ME)

Mumbai central gurgaon

17

gurgaon gurgaon
18

gurgaon gurgaon
19

Sunday Sunday
20

gurgaon gurgaon
21

gurgaon gurgaon
22

gurgaon gurgaon
23

gurgaon gurgaon
24

Note: Kindly Fill Work Details for all the days (1) On any day, if you have not incurred any expences then also just mention the work place / travels details / leave (2) incase you
are not worked on any particular day like sunday or holiday, then just mention as Sunday or Holiday
 Weekly Routine Expense / Work Detail Statement Page 6
Emp No: 96883 Name: Harit deewan Head Quarter: gurgaon Desgition:
Month: oct From 1/10/2013 TO: 31-10-2013 Tel./Mob.No.:
Places of Travel Dsecription of Local Telephone calls
Local
Total Tele Travel / Non- Description of
H.Q. or Tel.Exp.Amt.
Date STD Exp. Expenses Routine Exp. Travel / Other
From To OS (For Dm + O/S Name of the person SPL No. of calls made (Local+Std) Amt Expences
ME)

Sunday Sunday
25

gurgaon gurgaon
26

sunday sunday
27

gurgaon gurgaon
28

gurgaon gurgaon
29

gurgaon gurgaon
30

gurgaon gurgaon
31

Note: Kindly Fill Work Details for all the days (1) On any day, if you have not incurred any expences then also just mention the work place / travels details / leave (2) incase you
are not worked on any particular day like sunday or holiday, then just mention as Sunday or Holiday
 Page 7
Desgition: TM
Tel./Mob.No.: 8287428197

Internet Total
Total No. Of Bills / Vouchers
Exp.Amt Amount

Total Expences for the week

 Page 8
Desgition: TM
Tel./Mob.No.: 8287428197

Internet Total
Total No. Of Bills / Vouchers
Exp.Amt Amount

Total Expences for the week

 Page 9
Desgition: TM
Tel./Mob.No.: 8287428197

Internet Total
Total No. Of Bills / Vouchers
Exp.Amt Amount

Total Expences for the week

 Page 10
Desgition: TM
Tel./Mob.No.: 8287428197

Internet Total
Total No. Of Bills / Vouchers
Exp.Amt Amount
 864
960
929
960
960
898
1056
1022
1056
1056
1056
1056