Patanjali Ayurved Ltd - Distributor Stock Expiry/Damaged Form

Distributor Name : PHOENIX GROUP Claim Date :

Distributor Address : NEAR MANAV SEWA ASHRMA, RAJBAGH,CITY, SAWAI MADHOPUR Town :
Name of Sales Officer:
Name of ASM:
DB SAP Code No: Area:
Distributor Phone No: Name of ZM:
Under SD Name: Period of Claim : From 01.04.2017 to 30-11-2017

Sub: Damage & Expiry Claim for the Vertical :

A B C D E F G H I K

Distributor
landed price Total Value of expired stocks as per Classification of Stock Return
Sl No Brand SKU Exp Date MRP considering No of pieces DB Landing Price in Rs. H = (F*G)
(Market Damage / Distributor Remarks
scheme operated Godown Expiry / Quality Issue)
in Rs.

1 BESEN 500GM 7 23-12-16 90 80.88 1 80.88 Market EXPIRED

2 NAVRATAN ATTA 2KG 7 16-Nov 140 125.81 1 125.81 Market EXPIRED
3 RASGULLA 1 kg 12 Jun-16 150 128.21 9 1153.85 Market EXPIRED
4 KALI MIRCH PAPAD 12 16-Nov 50 42.74 25 1068.38 Distributor Godown Expiry
5 KALI MIRCH PAPAD 12 17-Mar 50 42.74 48 2051.28 Distributor Godown Expiry
6 DOODH POWDER 200GM 12 17-Jan 85 72.65 19 1380.34 Distributor Godown Expiry
7 JAMUN SIRKA 500GM 12 16-Jul 65 55.56 1 55.56 Distributor Godown Expiry
8 CHOCO FLEX 125GM 125GM 12 16-Oct 55 47.01 1 47.01 Distributor Godown Expiry
9 KALI MIRCH POWDER 100G 12 16-Dec 125 106.84 15 1602.56 Distributor Godown Expiry
10 CHOLE MASALA 100GM 12 16-Sep 38 32.48 2 64.96 Distributor Godown Expiry
11 SABZI MASALA 100G 12 16-Aug 38 32.48 3 97.44 Market EXPIRED
12 GARAM MASALA 100G 12 16-Dec 65 55.56 8 444.44 Market EXPIRED
13 HALDI POWDER 100G 12 16-Apr 24 20.51 3 61.54 Market EXPIRED
14 AMLA KHATTI CHUTNY 500GM 12 16-Oct 55 47.01 14 658.12 Distributor Godown Expiry
15 AMLA KHATTI CHUTNY 500GM 12 16-Nov 55 47.01 4 188.03 Distributor Godown Expiry
16 ISBGOL 100G 12 16-Sep 90 76.92 5 384.62 DAMAGED RECVIED
17 ANARDANA CHURUN 100G 12 16-Oct 35 29.91 20 598.29 NEAR EXPIRY RECEIVED,
GODWN EXPIRY
18 NARIYAL BISCUIT 300G 12 16-Nov 30 25.64 10 256.41 DAMAGED/EXPIRED RECVIED
WITHOUT ORDER
19 MASALA OATS 200GM 12 16-Nov 68 58.12 15 871.79 REC/EXPIRED
MOOGDAL 200G
20
NAMKEEN
200GM 12 16-Sep 52 44.44 2 88.89 Market EXPIRED
WITHOUT ORDER REC 60
21 ATTA NOODALS 70G 12 16-Sep 15 12.82 159 2038.46 CRTOON/EXPIRED

22 NATKHAT-5 12 17-Jan 5 4.27 71 303.42 Market EXPIRED

23 CHOCO DELITE 12 17-Apr 10 8.55 105 897.44 Market EXPIRED
24 MASALA OATS 200GM 12 16-Oct 59 50.43 60 3025.64 WITHOUT ORDER REC 60
CRTOON/EXPIRED
NEAR EXPIRY RECEIVED,
25 NAT-KHAT BISCUIT 12 17-Feb 5 4.27 200 854.70 GODWN EXPIRY
NEAR EXPIRY RECEIVED,
26 NAT-KHAT BISCUIT 12 17-Feb 5 4.27 180 769.23 GODWN EXPIRY
27 NAT-KHAT BISCUIT 12 16-Dec 10 8.55 10 85.47 MARKET DAMAGED/EXPIRED
28 NAT-KHAT BISCUIT 12 17-Jan 10 8.55 38 324.79 NEAR EXPIRY RECEIVED,
GODWN EXPIRY
29 NAT-KHAT BISCUIT 12 17-Apr 10 8.55 10 85.47 MARKET DAMAGED/EXPIRED
30 CORN FLEX 250G 250G 12 16-Dec 55 47.01 22 1034.19 Distributor Godown Expiry
31 CHOCO FLEX 125GM 125GM 12 16-Oct 55 47.01 11 517.09 Distributor Godown Expiry
NEAR EXPIRY RECEIVED,
32 NAMKEEN BISCUIT 12 16-Oct 10 8.55 44 376.07 GODWN EXPIRY
33 MARRY 250G 12 17-Mar 30 25.64 2 51.28 MARKET DAMAGED/EXPIRED
34 JAMUN SIRKA 500GM 12 17-Jun 65 55.56 3 166.67 MARKET DAMAGED/EXPIRED
WITHOUT ORDER
35 MASALA OATS 12 16-Nov 15 12.82 144 1846.15 REC/EXPIRED
WITHOUT ORDER
36 CHHOLE MASALA 12 16-Sep 45 38.46 100 3846.15 REC/EXPIRED
DAMAGED INSIDE CARTOON
37 TOMATO KETUP 1LTR 12 17-Mar 75 64.10 3 192.31 RECVIED
38 TOMATO KETUP 500GM 12 17-Mar 75 64.10 6 384.62 DAMAGED INSIDE CARTOON
RECVIED
WITHOUT ORDER
39 GARAM MASALA 100GM 12 16-Dec 65 55.56 60 3333.33 REC/EXPIRED
WITHOUT ORDER REC 60
40 ATTA NOODALS 70GM 12 16-Sep 15 12.82 1152 14769.23 CRTOON/EXPIRED
WITHOUT ORDER
41 ORANGE SQUAE 1LTR 15 16-Jan 75 64.10 2 128.21 REC/EXPIRED
42 MIX FRUIT JUICE 200GM 15 17-May 20 16.72 27 451.51 DAMAGED/EXPIRED RECVIED
43 MANGO JUICE 200GM 15 17-Mar 20 16.72 18 301.00 DAMAGED/EXPIRED RECVIED
44 MANGO JUICE 200GM 15 17-Mar 20 16.72 53 886.29 DAMAGED/EXPIRED RECVIED
WITHOUT ORDER NEAR
45 ORANGE SQUAE 1LTR 15 16-Apr 75 64.10 36 2307.69 EXPIRED REC.
WITHOUT ORDER NEAR
46 ORANGE SQUAE 1LTR 15 16-Apr 75 64.10 12 769.23 EXPIRED REC.RECEIVED,
NEAR EXPIRY
47 TULSI PANCHAG 500GM 19-Jan 16-Aug 90 72.12 4 288.46 GODWN
48 POWERVITA REFIL 500GM 20 16-Dec 190 152.24 6 913.46 WITHOUTEXPIRY
ORDER
REC/EXPIRED
49 AMLA JUICE 1LR 1LTR 20 17-Sep 100 80.13 1 80.13 DAMAGED MARKET
WITHOUT ORDER
50 POWERVITA REFIL 500GM 20 16-Dec 190 152.24 7 1065.71 REC/EXPIRED
NEAR EXPIRY RECEIVED,
51 ANARDANA CHURUN 20 16-Oct 35 28.04 10 280.45 GODWN EXPIRY
52 LAUKI AMLA JUICE 1LTR 20 16-Jul 90 72.12 1 72.12 MARKET DAMAGED/EXPIRED
53 ALOEVERA PLAIN 1LTR 20 15-Apr 180 144.23 1 144.23 MARKET DAMAGED/EXPIRED
54 ALOEVERA FIBER 1LTR 20 17-Sep 200 160.26 3 480.77 MARKET DAMAGED/EXPIRED
Total 19,579

Credit Notes Received from SD during 2017 & 2016 Stocks destroyed during 2017
Date Amount (Rs.) Date Amount (Rs.)
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
Total 0 Total 0

I confirm that the above mentioned products have been taken back from the market based on Stocks Replacement Policy policy and have been completely destroyed
in the presence DB-SO-ASM/ZM on date _______________________________ or Despatched to SD Point on Date ________________________________

Verfified By : TSI / SO
& Signature Approved by National Head & Signature

Approved by - ASM &

Distributor Signature With Rubber Stamp →
Signature