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NOVO NORDISK INDIA PRIVATE LIMITED Plot No:3247-50, EPIP Area,White Field , Bangalore 560066 Name: Designation: Initials

s (email id): H.Q: HYDERABAD Date: Emp. No. FIELD FORWARDING SHEET . Request you to kindly release the amounts.

Following are the claims for the month of A: EXPEDITURE CLAIM Sl. No. 1. 2. 3. 4. 5. a. b. c. d. e. 6. Nature of Expenses

Travel Statement 1st fortnight Travel Statement 2nd fortnight CME Expenditure PEP EXPENDITURE Claims relating to Special Marketing Programmes Other Activitie) IMPROVE HbA1c (if any) IMPROVE other NNDU/ADA/ EASD/ Other foreign sponsorships Others( APICON-2010 Registration) Other claims (Taxi Fares claims)\MOBILE/M.REPAIR Total B. ADVANCES REQUIRED Details of programs for which advance is required Date of Program Amount Required

Sl. No. 1. 2. 3. 4.

Total Amount Claimed (Expense+Advance)

Total A+B Rs.

Signature

Approved by /RM/ZM

Approved (HO only)

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