Date: {{$ActivityAssignDate}}

To,


Mr. Sandeep Sharma


Associate Vice President

Sun Pharma Laboratories Limited,

Sun House, Plot No. 201,B/1,
Western Express Highway,
Goregaon (E), Mumbai 400063


Dear Mr Sandeep Sharma,


Subject: {{$ActivityName}}


In response to your letter dated 29st December’2022 I agree to participate in the survey as outlined by you.
I understand that:


  • You will provide me with the copy of a questionnaire ( softcopy )

  • Questionnaire would be used & the treatment would be prescribed as in my routine practice

  • The patient’s identity will not be disclosed in the DCF

My personal details are given below for accuracy of your records:

Name: {{$doctorName}}
Qualifications:
Speciality:
Postal Address:
Clinic/Hospital Tel. No. :
Residence Tel. No. :
* PAN Card No. :




Yours sincerely,

[Signature & Stamp]
{{$doctorName}}