MOTHR DAIRY FRUIT & VEGETABLE PVT. LTD.

Form `1`
Distributor Claims summary sheet
Priyanshu Traders

17-Mar

Location: Hathras___________________ R.S. Code : 1018562

S.No. Head of Claims Amount Claimed Amount Passed Deduction Reason for deduction
1 Secondary Schemes 12+1
2 Secondary Schemes 24+1
3 Damage/Shortage/Leakage 535.54
4 Butter Secondary
5 Cheese Secondary
6 Puff, Unset, Leakage
7 FM
8
9
10
Total 535.54

We hereby certify that the above mentioned claims are total claims for the reffered month and there is no claim pending till date except the
above mentioned .

We also state that the above mentioned claims are submission only and does not automatically tantamount to payment to me unlesss verified
by the company.

______________________________ _______________________________________________________________

Signature of Distributor Signature of ASM

______________________________ _______________________________________________________________
Signature of Executive Signature of RSM / Head Sal

Comment by Account group Credit Note Details

_________________________________ No. ___________________________________________________________
_________________________________ Date _________________________________________________________
Amount _______________________________________________________
 DAMAGE CLAIM
Priyanshu Traders
Code: 1018562 Period: Mar. 17

Location: Hathras CFA__PILKHUWA Disposal No._____

Damage % Promo +
Mfg. Date Batch Nature of Damage Damage QTY Salvaged Rate of Salvage
S. No. Product Sku MRP No. of units Value PTD Recover Sch Value Claim A-B-C)
No. / Code (Vol) QTY (VOL) Disposal Value (B)
(A) y Vol (C)
1 Tonned Curd 200 GM P52964CG MFD 20.00 PUFFED 0 0 0.00 0 0 16.80 0 0 0
2 POLY CURD 400 GM P53244CD USE 28.00 PUFFED 0 0 0.00 0 0 23.52 0 0 0
3 Mishti doi 85 GM P53301CGA1 MF 15.00 PUFFED 0 0 0.00 0 0 12.60 0 0 0
4 LASSI BOTTLE P53252AS MFD 18.00 PUFFED 0 0 0.00 0 0 15.55 0 0 0
5 CHHACH 400ml P52965AQ USE 10.00 PUFFED 0 0 0.00 0 0 9.19 0 0 0
6 FLAV.MILK 180 ML E52682B MFD 2 22.00 BROKEN 0 0 0.00 0 0 18.66 0 0 0
7 NUTRIFIT 80 ML 10.00 PUFFED 0 0 0.00 0 0 8.64 0 0 0
8 PANEER 200 GM E53222B1 MFD 65.00 PUFFED 0 0 0.00 0 0 57.53 0 0 0
9 BUTTER 100 GM D52914C2 MFD 44.00 FUNGUS 0 0.0 0.00 0 0 35.40 0 0 0
10 CHEESE 200 GM D52520BO MFD 130.00 FUNGUS 0 0 0.00 0 0 114.01 0 0 0
11 UHT 1 LTR E52941B1 MFD 60.00 PUFFED 0 0 0.00 0 0 52.62 0 0 0
12 YOGHURT 100 GM P53261AC MFD 20.00 PUFFED 0 0 0.00 0 0 17.30 0 0 0
13 ESL 500ml E52922AEC MFD 25.00 PUFFED 1 0 21.96 0 0 21.63 0 0 22
14 MILShake 200ml E52541C2 MFD 25.00 PUFFED 0 0 0.00 0 0 21.63 0 0 0
15 Lassi 200ml E52791A2 MFD 0 20.00 PUFFED 0 0 0.00 0 0 17.30 0 0 0
16 Dairywhitner 10kg 25.00 BROKEN 0 0 0.00 0 0 21.63 0 0 0
SMP 1kg 195.00 0 0 0.00 0 0 168.68 0 0 0
17 Chhach 200ml 12.00 PUFFED 0 0 0.00 10.38 0
18 Cream 200ml E51752 B1 Mfd. 185.00 PUFFED 3 0 513.59 160.03 514
Total 536 536
To be Filled in by SE

Month YTD
Sale to the Distributor (R.S) 104912.74 mar 2017
Damage Claim (R.S) 535.5
% Damage 0.5%
% Loss (R.S)**
** % Loss is total claims / Total damage value
I have personally verified the damaged stocks and attached the cuttings of Batch No. & MRP of damaged packs
jan.

______________________________
(Signature of Executive) _________________________

(Signature - R.S)
R.S. Seal

______________________________

(Approved by ASM)

TO BE FILLED AT THE TIME OF DESTRUCTION

0
I certify .
1 That the above mentioned damages are destroyed in my presense
2 I have personally checked the quantity and sending nos cartoons I certify . (Strike out which is not applicable)
1 I have destroy the above mentioned goods.
2 I am sending the above mentioned goods to the cfa

______________________________ _________________________
(Signature of Executive) (Signature - R.S)
R.S. Seal
Date of destruction____________________
COLD CHAIN PRODUCTS (CCP)-FRESH

Mother Dairy Fruit & vegetable Pvt. Ltd.

Distributor Claims summery Sheet

42811

Location : Agra Flavor Milk Sec. Sch.

Date BILL NO. Sale in carRs. @18.8/-.per Crate.

From To
1
2
3
4
5
6
7
8
9
10
11 42 44 6 112.2
12 48 48 4 74.8
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30 88 92 10 187
31 96 99 0
Total 20 374
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