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Aureus Division

ISA APPROVAL REQUEST FORM

Name of DM/RSM/BALRAM.G HQ : HYDERABAD Date : 24-05-2011

Name of Doctor (ALL CAPS) DR . NARENDRA

Qualification MD CHEST PHY, HOD DEPT OF PULMONOLOGY

Address GOVT CHEST HOSP,ERRAGADDA,HYDERABAD-12

DM's Name & HQ BALRAM.G ,HYDERABAD


Month 1 Month 2 Month 3
Last 3 month Primary & Secondary Sales of
PRI 1.32 1.06 1.33
SO HQ
SEC 1.13 1.1 1.12

ISA Amount 12,000/-

Details of ISA VELCERA CME

Cheque / Draft payable in the name of (ALL


BALRAM.G ,HYDERABAD
CAPS)

Payable at (Town Name) HYDERABAD

Business Perspective
Product Current (Rs.) Expected (Rs.)
VELCERA 200 200 UNITS OF VELCERA 200/20,000 RS
VELCERA 400 200 UNITS OF VELCERA 400/25,000/RS

BALRAM.G
DM Signature RSM SM VP Approved by DLA

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