[ON THE LETTERHEAD OF THE DISTRI

Discount Net Rate Sheet (Refer Note 1 below) - B

Distributor Name: SHIV ENTERPRISES

Distributor Address: SAPHALE

Date Retailer Name Bill No. Channel Product

(Refer Note 2 below) (e.g.: (Name and Pack
Wholesale size)
/ Retail /
Railway /
31.03.2022 ROSHAN GENERAL STORE 2125 RETAIL
Bus Stand FM 2 LTR
31.03.2022 MAMATA KIRANA etc.)
2124 RETAIL FM 2 LTR
31.03.2022 ANNAPURNA SWEET 2126 RETAIL FM 2 LTR

Total
Prepared by:
Name:

Designation: Distributor Representative

Signature and Stamp of Distributor:

Date:

Note:
1. Please attach circular or email approval for the claim
2. Please attach acknowledged bills from all Retailers
 Annexure 3D
HEAD OF THE DISTRIBUTOR]
Sheet (Refer Note 1 below) - Beverages
Area: SAPHALE

Claim for the Month of: March- 2022

Billed Billed Discounted Retailer Difference Claim Amount

Quantity Amount Net Rate Landing (e) (f)
(Cases) (b) (c) Rate (e = d - c) (f = e * a)
(a) (c = b / a) (d)

10 4,320.00 432.00 476.18 44.18 441.80

10 4,320.00 432.00 476.18 44.18 441.80
10 4,500.00 450.00 476.18 26.18 261.80

- - - -

30 1,145.40
Checked by:
Name:

Designation: GO or TGI or BDE or AGM

Signature :
Date:
 [ON THE LETTERHEAD OF THE DISTRIBUTOR]
Secondary Trade Scheme Summary Statement - Beverages (Only for High Value
Distributor Name: SHIV ENTERPRISES

Distributor Address: SAPHALE

Claim for the Month of: Mar-22

SKU Name Scheme Slab Quantity

(Refer note 1 below) Quantity Sold Scheme Quantity
(Cases) (Packs)
(Carry forward from (b)
annexure 3B)
(a)

FM & AC TETRA 150 ML 6+40 PC 82 544

AF & BF 160 ML 5+ 25 PC 30 150
FM PET 300 ML 5+30 PC 5 30

Total 117 724

Prepared by:
Name:

Designation: Distributor Representative

Signature and Stamp of Distributor:

Date:

Note:
1. Please mention the scheme slab. E.g.: 5+1, 6+1 etc.
 Annexure 3C
F THE DISTRIBUTOR]
erages (Only for High Value / High Volume / Key Outlets)
Area:SAPHALE

Quantity Value in Rs.

Scheme quantity Difference Distributor Claim
given by PAPL as (Packs) Landing Rate Amount
Net Rate in (d) (e) (f)
Invoice (Packs) d=b-c f=d*e
(c)

328 216 8.02 1732.32

60 90 9.88 889.20
19.6 10.4 15.59 162.14

407.6 316.4 2783.66

Checked by:
Name:

Designation: GO or TGI or BDE

Signature:
Date:
 [ON THE LETTERHEAD OF THE DISTRIBUT
Secondary Trade Scheme Bill Wise Details Statement - Beverages (Only for H
Distributor Name: SHIV ENTERPRISES

Distributor Address: SAPHALE

Claim for the Month of: March-2022

(Refer Note 1 below) FM & AC TETRA 150 ML

Date Retailer Name Bill No. Number of Cas
Scheme Slab 1
(6+40 PC)

28.02.2022 MAMATA KIRANA 2118 8+52 PC

04.03.2022 ANNAPURNA SWEET 2056 6+40 PC
05.03.2022 ANNAPURNA SWEET 2120
05.03.2022 BIGG MEDICINE 2070 6+40 PC
05.03.2022 KISHAN DOODH DAIRY 2071 6+40 PC
12.03.2022 ANSH FARSAN 2096
12.03.2022 ANNAPURNA SWEET 2121 8+52 PC
31.03.2022 ROSHAN GENERAL STORE 2125 12+80 PC
31.03.2022 MADHURA DRY FRUIT 2122 12+80 PC
31.03.2022 MAMATA KIRANA 2124 12+80 PC
31.03.2022 ANNAPURNA SWEET 2126 12+80 PC

Total scheme quantity (carry forward to Annexure 3B) 82+544 PC

Prepared by:
Name:

Designation: Distributor Representative

Signature and Stamp of Distributor:

Date:
Note:
1. Please attach acknowledged bills from all High Value Outlet schemes operated beyond the inbuilt sche
2. Please mention the number of cases sold under the scheme slab. E.g.: 5+1, 6+1 etc.
EAD OF THE DISTRIBUTOR]
ment - Beverages (Only for High Value / High Volume / Key Outlets)
Page No:01

Area: SAPHALE

& AC TETRA 150 ML AF& BF 160 ML FM300 ML

Number of Cases sold under Scheme (Refer Note 2 below)
Scheme Slab 2 Scheme Slab Scheme Slab Scheme Slab Scheme
(5+25 PC.) 1 (5+25 PC) 2 1 (5+30 PC) Slab 2

5+30 PC

5+25 PC

5+25 PC
10+50 PC
5+25 PC
5+25 PC

30+150 PC 5+30 PC

Checked by:
Name:

Designation: GO or TGI or BDE

Signature:
Date:
ated beyond the inbuilt scheme
 PARLE AGRO PVT LTD
SUMMARY STATEMENT - PRODUCT DAMAGE CLAIM
Date : Mar-22 Month:March -2022 SAP Code: 1007073
Channel Partner Name and
Address Stamp: SHIV ENTERPRISES
SHOP NO. 01, ABDUL BLDG. UMBAR PADA SAPHALE EAST

To be filled by Growth Officer / Area Growth Manager / R

Brand SKU Reasons for Damages (Quantity)
Bloated Soggy / Leakage Blackeni Fungus Empty / Color Bad
(a) Puffed (c) ng (e) Half faded taste or
(b) (d) filled (g) odour
(f) (h)

TCA 65 ml 24.00
Tetra 160 ml 27.00
Tetra 200 ml
PET 160 ml
FROOTI PET 300 ml 6
PET 600 ml 2
PET 1200 ml 0
PET 2000 ml 1
FROOTI TOTAL 9.00 - 51.00 - - - - -
Tetra 160 ml 8.00
AC PET 160 ML
APPY TOTAL - - 8.00 - - - - -
Can 250 ml
PET 250 ml 6
APPY PET160ml 4
FIZZ (12 MRP)
PET 600 ml 2
PET 1000 ml 3
APPY FIZZ TOTAL 15.00 - - - - - - -
PET160ml
(12 MRP) 3
B FIZZ PET 250 ml
Can 250 ml 0
B FIZZ TOTAL 3
CHOCOLATE
SMOODH TOFFEE
COFFEE
SMOODH TOTAL 0
GRAND TOTAL 27.00 - 59.00 - - - - -
We certify that above is a summary of damaged stock which was counted and destroyed i
the budgetary limit. Total value of damaged stock destroyed is Rs. 951.22

Name: SATYENDRA KUSHWAHA

Area Growth Manager / Regional Growth Manager
Contact No: 8433701315

Signature:
Date:
LE AGRO PVT LTD
CT DAMAGE CLAIM FROM CHANNEL PARTNER
1007073 Date of Destruction: 31.03.2022
S Total No. of Retailer and CP Product Damage Claim Forms
attached to this Summary

SAPHALE EAST

rea Growth Manager / Regional Growth Manager

Total Batch No. Manufacturing Price to Value of
Other (j) Damaged Date Manufac Channel Damaged
Deshape Quantity
(a - j) turing Partner Stock
d (i) Plant net of (C)=(A)*(B)
(A)
schemes
24.00 PTG22033 02.02.2022 PTG incl.
4.00 96.00
27.00 PTG 22029 29.01.2022 PTG 8.02 216.54
- -
- -
6.00 BHP22037 06.02.2022 BHP 15.56 93.36
2.00 PTG22034 03.02.2022 PTG 30.24 60.48
- -
1.00 PTG22029 29.01.2022 PTG 75.59 75.59
- - 60.00
- 8.00 PTG22027 27.01.2022 PTG 8.02 64.16
- -
- - 8.00
- -
6.00 PTG22026 26.01.2022 PTG 14.03 84.18
4.00 PTG22028 28.01.2022 PTG 9.98 39.92

2.00 PTG 22016 16.01.2022 PTG 26.69 53.38

3.00 PTG22013 13.01.2022 PTG 45.89 137.67
- - 15.00
3.00 PTG22037 06.02.2022 PTG 9.98 29.94

- -
- -
3
- -
- -
- -
0.00
- - 86.00 951.22
h was counted and destroyed in our presence at the Retail Outlet and CP location and is within
d is Rs. 951.22

Name: DALCHAND NAGADA

Channel Partner Representative
Contact No: 9545211198

Signature:
Date:
 4260
78.169014

35300 100 100 47.88

55100 100 200 25.08
31122 42 100.8
23772 11 47 17.71386
145294 253 447.8

3196 3676 3284 392

416
1120
 SUMMARY SHEET
SHIV ENTERPRIS

FM160
TCA FM FM FM
SR. NO. OUTLET NAME 65ML 160ML
ML
300ML 600ML
PET

1 JAGDAMBA DRY FRUITS 11

2 PITRUCHAYA GENERAL
3 OM BHOJNALAY 2
4 ROSHAN GENERAL STORE 2 2 1
5 MAMTA KIRANA STORE 10 4
6 ANNAPURNA SWEET 1
7 SHREE KRISHNA FARSAN MART 12 8
8 KISHAN DOODH DAIRY 6

TOTAL 24 27 0 6 2
RATE PER PC. 4 8.01 8.37 15.56 28.72
VALUE 96 216.27 0 93.36 57.44
SUMMARY SHEET (March -2022)
SHIV ENTERPRISES (1007073)

FM APPY ACL
FM FIZZ FIZZ FIZZ FIZZ B FIZZ B FIZZ CHOCO TOFFE
1200M CL PET 160
2000ML 160ML 250ML 600ML 1000ML 160ML CANE 85 ML E 85 ML
L 160ML ML

1 1
3 1 3
8 4
2
1
1 1

0 1 8 0 4 6 2 3 3 0 0 0
52.56 75.59 8.01 8.37 8.37 14.03 24.95 44.81 8.37 17.93 8.38 8.38
0 75.59 64.08 0 33.48 84.18 49.90 134.43 25.11 0 0 0
COFFE
TOTAL VALUE
E 85 ML

13 160.80
7 117.92
14 120.12
7 97.42
15 116.27
3 102.82
20 112.16
7 123.71
0 0.00
0 0.00
0 0.00
0 86 951.22
8.38 0 0
0 0 951.22
 PAVI DISTRIBUTORS
Distributor Monthly Claim Top Sheet - Beverages

Distributor Name: SHIV ENTERPRISES

Area: SAPHALE Claim for the Month of:
PART A
Product Pack Size Quantity (In Cases)
Purchase Sales Secondary
(Primary) (Secondary) Trade
Scheme
(Regular)
Annexure Reference Annexure 2 - Annexure 2 - Annexure 3C
column B column H
Frooti TCA 65 ML / 64 60 56
Frooti Tetra 200 ML / 30 0 0
Frooti Tetra 160 ML / 40 250 242
Appy Tetra 160 ML / 40 100 102
Appy Tetra 200 ML / 30 0 0
Frooti Pet 160 ML / 40 49 44
Frooti Pet 300 ML / 30 45 39
Frooti Pet 600 ML / 24 24 19
Frooti Pet 1.2 LTR / 12 10 7
Frooti Pet 2 LTR / 6 54 49
Appy Fizz Pet 160 ML / 40 114 103
Appy Fizz Pet 250 ML / 30 55 51
Appy Fizz Pet 600 ML / 24 30 41
Appy Fizz Pet 1 LTR / 12 50 43
Appy fizz Can 250ml /24 7 3
B Fizz Pet 160 ML / 40 10 12
B Fizz Pet 250 ML / 30 0 0
B Fizz Pet 600 ML / 24 0 0
B Fizz Pet 1 LTR / 12 0 0
B Fizz Can 250ml /30 0 0
Smoodh Chocolate 85 ML/40 16 18
Smoodh Toffee Caramal 85 ML/40 10 9
Smoodh Coffee 85 ML/40 10 7
TOTAL PART A 894 845
PART B
 Particulars Annexure No.
Display Annexure 4A
VAT Reimbursement and 4B 11
Annexure
DD Charges Annexure 12
Rate Difference (Due to
Invoicing)
Special Events
Others - Please specify SECONDRY CLAIM March - 2022
TOTAL PART B

TOTAL CLAIM (A + B)

Claim Certificate: This is to certify that we have checked and verified the schemes and / or discount
given by the distributor M/s SHIV ENTERPRISES in the market for the month of March -2022 a
certify the genuineness of the claim and would be responsible for any discrepancy found.

Name: Name:

Designation: Distributor Representative Designation: GO or TGI or BDE

Signature and Stamp of Distributor: Signature:

Date: Date:

Approved by Checked and Verified by

Name: SACHIN KULKARNI Name:

Designation: RGM Designation: Regional Accountant

Signature: Signature:
TRIBUTORS
laim Top Sheet - Beverages

Date: 01.04.2022
aim for the Month of: Mar-22

Value in Rs.
Secondary Discounts Total Value
Trade Net Rate
Scheme
(Railways)
Annexure Annexure 3D
3C
 Value in Rs.

LAIM March - 2022 3,929.00

3929.00

3929.00

he schemes and / or discounts and / or display and / or damages quantities

he month of March -2022 and found the same to be in order. We further
iscrepancy found. `

Name: SATYENDRA KUSHWAHA

O or TGI or BDE Designation: AGM

Signature:
Date:

Approved by
Name:

gional Accountant Desig:: BH or BM

Signature:
 SHIV ENTERPRISES
CERTIFICATE OF CLAIMS PENDING SUBMISSION TO PARLE AGRO PVT. LTD. & BALAN

To,

The Business Head or Business Manager or Business Development Manager : Mr. Suresh Singh
Parle Agro Pvt. Ltd.
__MUMBAI_____ (mention Region / State)

CERTIFICATE OF CLAIMS PENDING SUBMISSION BY DIS

*
This is to certify that I / We do not have any claims pending submission to Parle Agro Pvt. Ltd. for the mo
______ (mention year)

*
This is to certify that I / We have the following claims pending submission to Parle Agro Pvt. Ltd.

Claim for the

Claim head
Month
Mention details
Mar-22 SECONDRY CLAIM
Mar-22 GODOWN DAMAGE ( AF CANE)
Mar-22 REGULAR DAMAGE
TOTAL

BALANCE CONFIRMATION

This is to certify that a sum of Rs. 57064.46 is due from March 2022 due to March 2022 Parle Agro Pvt. Ltd. as pe

Name:

Designation: Distributor Representative

Stamp & Signature of Distributor:

Date:
NTERPRISES
LE AGRO PVT. LTD. & BALANCE CONFIRMATION

01.04.2022

Manager : Mr. Suresh Singh

ENDING SUBMISSION BY DISTRIBUTOR

n to Parle Agro Pvt. Ltd. for the months of April to September / October to March

OR

Parle Agro Pvt. Ltd.

Amount of
Claim

3929.00
2184.24
951.22
7,064.46

CE CONFIRMATION

March 2022 Parle Agro Pvt. Ltd. as per our books of accounts as on 01/04/2022.
 To be prepared by GO / AGM / RGM aft

PA
PRODUCT DAMAGE CLAIM FORM
Date of Claim: 31.03.2022 Month: Mar-22

Channel Partner Name and

Address Stamp:
SHIV ENTERPRIS
SHOP NO. 01, ABDUL BLDG. UMBAR PAD
To be filled by Growth Officer / Area
Brand SKU Reasons for Damages (Quan
Bloated Soggy / Leakage Blackenin Fungus
(a) Puffed (c) g (e)
(b) (d)
TCA 65 ml
Tetra 150/160 ml
Tetra 200 ml
PET 160 ml
FROOTI PET 300 ml
PET 600 ml
PET 1200 ml
PET 2000 ml
FROOTI TOTAL
Tetra 150/160 ml
Tetra 200 ml
PET 160 ml
APPY TOTAL
Can 250 ml 3
PET 160 ml
APPY FIZZ PET 250 ml
PET 600 ml
PET 1000 ml
APPY FIZZ TOTAL
PET 160 ml
PET 250 ml
B FIZZ
PET 600 ml
Can 250 ml
B FIZZ TOTAL
CHOCOLATE
SMOODH
CARAMAL
SMOODH TOTAL
GRAND TOTAL

Name: Rishi dubey

Growth Officer / Area Growth Man

Growth Manager
Contact No:8433701315

Signature:
Date:
AGM / RGM after destruction of damaged stock at Channel Partner location

PARLE AGRO PVT LTD

E CLAIM FORM - CHANNEL PARTNER (in case any damage at CP location)
SAP Code: 1007073 Date of Destruction:

V ENTERPRISES
L BLDG. UMBAR PADA SAPHALE EAST
Growth Officer / Area Growth Manager / Regional Growth Manager for Product Damage
ns for Damages (Quantity) Total Batch No.
Empty / Color Bad taste Deshaped Other (j) Damaged
Half faded or odour (i) Quantity
filled (g) (h) (a - j)
(f) (A) -
-
-
-
-
-
-
-
 Name: DALCHAND NAGDA
i dubey
Channel Partner Representative
icer / Area Growth Manager / Regional Contact No:9029668549
nager
:8433701315
Signature:

Date:
l Partner location
Annexure 2

CP location)
31.03.2022

ge
Manufacturing Price to Value of
Date Manufacturin Channel Damaged
g Plant Partner Stock
net of (C)=(A)*(B)
schemes
incl. VAT
(B)
 PARLE AGRO PVT LTD
SUMMARY STATEMENT - PRODUCT DAMAGE CLAIM FROM CHANNEL PARTNER
Date Aug-22 Month:AUGST -2023 SAP Code: 1017881 Date of Destruction:.1-9-23 1.08.2023
Channel Partner Name
and Address Stamp: OM TRADING CO Total No. of Retailer and CP Product Damage Claim Forms
attached to this Summary

SHOP NO. 4,SHANKESHWAR NAGAR NALASOPARA EAST

4260
To be filled by Growth Officer / Area Growth Manager / Regional Growth Manager 78.169014
SKU Reasons for Damages (Quantity) Total Batch No. Price to Value of
Bran Bloated Soggy / Leakage Blackeni Fungus Empty / Color Bad Damaged Manufacturing Manufa Channel Damaged
d (a) Puffed (c) ng (e) Half faded taste or Quantity
(a - j) date cturing Partner Stock
(b) (d) filled (g) odour Plant net of (C)=(A)*(B)
(f) (h) (A)
schemes
TCA 65 ml 58.00 32.00 90.00 22-06- ptg incl. VAT
4.00 360.00
ptg23173,23152, 2023,1/6/23,2/6/2
Tetra 160 ml 106.00 69.00 81.00 256.00 bhp23153, 3,
1/6/23,29/6/23,6/ ptg 8.01 2,050.56
ptg23152,23180, 4/23,7/6/23,3/6/2
23086,23158,231 3,20/4/23,19/4/23
54,23110,23109, ,22/6/23,30/6/23,
23173,23181

Tetra 200 ml ptg

PET 160 ml
PET 300 ml 9 38 59 14 7 30 ptg
bhp23147,ptg23159,23148,bhp23173,23142,23141,23168,23163,23178,
165.00 27/5/23,8/6/23,26 15.56 2,567.40
FRO /5/23,22/6/23,17/
OTI 8 6/23,21/5/23,22/5
/23,12/6/23,27/6/
23,
PET 600 ml 8 4 5 8 10 5 40.00 17/6/23,1/6/23,28 ptg 28.72 1,148.80
ptg23168,23152, /6/23,25/5/23,6/6/
23179,23145,231 23,18/3/23,,
57,23077,

PET 1200 ml 2 2.00 ptg23156, 5/6/23, 52.63 105.26

PET 2000 ml 6 4 3 7 4 24.00 ptg23180,23115, 30/6/23,25/4/23,3 ptg 75.59 1,814.16
23171,23181, 0/6/23,

FROOTI TOTAL
APPY Tetra 160 8.00 20.00 12.00 40.00 ptg23178,23157, 27/6/23,6/6/23,20 ptg 8.01 320.40
ml 23147, /6/23,27/5/23,

AC PET 160 ML
APPY TOTAL
Can 250 ml 19.13
PET 250 ml 5 5 2 3 5 20.00 ptg23178, 27/6/23, ptg 16.01 320.20
APP PET160ml
Y (12 MRP)
FIZ
Z PET 600 ml 6 2 13 4 25.00 ptg23157,23213, 6/6/23,1/8/23,, ptg 24.95 623.75

PET 1000 ml
APPY FIZZ TOTAL
PET160ml
B (12 MRP)
FIZ PET 250 ml
Z
Can 250 ml
B FIZZ TOTAL
CHOCOLATE 36 16 52.00 mys23174,23108 23/6/23,18/4/23, mys 8.37 435.24
SMO TOFFEE ,
5 5.00 bhp23193, 12/7/23, bhp 8.37 41.85
ODH
HEZELNUT 8.37
SMOODH TOTAL
GRAND TOTAL 133.00 148.00 191.00 82.00 55.00 18.00 62.00 30.00 719.00 9,787.62
We certify that above is a summary of damaged stock which was counted and destroyed in our presence at the Retail Outlet and CP
location and is within the budgetary limit. Total value of damaged stock destroyed is Rs. 2184.24

Name: RISHI DUBEY Name: JIGNESH MISTRY

Area Growth Manager / Regional Growth Manager Channel Partner Representative
Contact No: 8591372224 Contact No: 9323985479

Signature: Signature:
Date: Date:
 SUMMARY SHEET
SHIV ENTERPRIS

FM160
TCA FM FM FM
SR. NO. OUTLET NAME 65ML 160ML
ML
300ML 600ML
PET

1
2
3 18
4
5
6
7
8

TOTAL 0 0 0 0 18
RATE PER PC. 4 8.01 8.37 15.56 28.72
VALUE 0 0 0 0 516.96
SUMMARY SHEET (March -2022)
SHIV ENTERPRISES (1007073)

FM APPY ACL
FM FIZZ FIZZ FIZZ FIZZ B FIZZ B FIZZ CHOCO TOFFE
1200M CL PET 160
2000ML 160ML 250ML 600ML 1000ML 160ML CANE 85 ML E 85 ML
L 160ML ML

24
10

0 0 0 0 0 0 24 10 0 0 0 0
52.56 75.59 8.01 8.37 8.37 14.03 24.95 44.81 8.37 17.93 8.38 8.38
0 0 0 0 0 0.00 598.80 448.1 0 0 0 0
COFFE
TOTAL VALUE
E 85 ML

24 640.56
10 458.90
18 544.32
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 52 1643.78
8.38 0 0
0 0 1643.78