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(TO BE PREPARED BY ZBM)
Date of Proposal:
Doctor s Name: Dr.VISHWAS PHADKE.
Specialty: M.S.ORTHO.
DML Code No:115952
SURYAVANSHI.
BE/BM's HQ:

CAT:

Qualification &

BM/BE Name: Mr.SHEKHAR

Sangli.Maharashtra

BM/BE Code: MH 509

HQ's PCPM:
Address

(With STD Code) RESI: 02332332609

MOBILE :

CLINIC

: PHADKE NURSING HOME.

E-MAIL

Visit Details of Field Staff to the Doctor

(Details of Visits form one month prior to the month of Proposal send)
Designation

April

May

June

July

August

September

October

ZBM
RBM
BE / BM

20

18

21

ROI Details:
Name of Products
Prescribed
Present Support

Expected Support
(After Proposal)

Dynapar MR

Dynapar Gel

Febutroy 80

Qty. in
Boxes
PTS.
Rs/Qty. in
Boxes

100

50

20

14000

3000

16000

200

100

30

PTS.
Rs/-

28000

58000
6000

24000

Incremental Sales Plan in the territory after the patron :

Product Name
1
2
3
4 Total Primary Sale

Month - 1

Total Rs/Per Month

33000

Month -2

Month - 3

Month -4

Sales Details of Patron HQ:

Details of Retailer Near Patron Dr:
Sr.No.
1

Name of Chemist / Medical

Store
SWARUP MEDICALS,SANGLI

Contact Person's
Name
MR.SWARUP WATVE.

Phone No.
9422040514

Doctor's Vital Details :

Date of Birth : _____________________________________
Marriage Anniversary : ______________________________
Clinic Opening Day : ________________________________
Type of Proposal / Service to be provided to the Doctor :
(1) Book or Journal Subscription
(2) Air / Train Ticket Booking or Air / Train Ticket Reimbursement
(3) Hotel Stay
(4) Personal Gift
(5) IDBI Debit Card
Details & Cost of Proposal: ( To be provided completely, incomplete information will
not be processed further )
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Previous Proposal Details if any:

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Request from: ______________________Recommended By: ________________________

ZBM's Remark:______________________________________________________________
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SM / AGM / DGM / GM's Remark:
___________________________________________________________________________
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S.P.D.'s Remark:_____________________________________________________________
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