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Division Info

Division Name *

Division Code *

Cluster Name *

Company Name *

GST No *

Activity Info

Activity Type *

Activity EC Selection *

Allocated hour *

Activity Name (Visible for Field and HO Team) *

Activity Title (As per Study Protocol) *

Field Assign Flow *

Field team approval Flow *

HO Final approval Flow *

Doctor Approval Flow *

Activity capping amount *

FY Year * (E.g: {{ get_fiscal_year() }})

Do you require a pre-read document for this activity? *

Yes

Activity Amount Slab *

Other Amount

Activity Expiry Days *

EC Approval Date *

Study activation duration (months) *

Last assign date *

GL code *

No doctors proposed *

Target date of completion *

Target doctor specialization *

Consultancy Agreement Info

Authorized Signatory Name *

Study Objective *

Description of services *

Authorized signatory (Allowed JPG, JPEG & PNG files)

Document Info

Upload DCF Form/Survey questionnaire * (Allowed Word & PDF Files)

Upload Proposal Letter *(Allowed only PDF)

Approval Reference of Medical/Compliance * (Allowed only PDF)

Upload Survey Protocol * (Allowed only PDF)

Upload EC certificate * (Allowed only PDF)

Upload Pre-read Document * (Allowed only PDF)

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Upload prescribing information (Allowed only PDF)

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Other Info

Brand *

Study Protocol Number*

Survey Purpose *

Outcome Expected * {{-- --}}

No of Question *

Is the same survey used in the last year ? *

Reason, if the survey is repeated *

Total budget amount for activity *

Utilization of Survey Outcome *

Other Outcome *