Meal or Beverage Request

Please click on information icons located next to each question for specific approver guidance. Approval is only required when meals or beverages exceed applicable Country Limits for the country where the meal or beverages will be provided.

Purpose

The meal is... The business purpose is...

Are the meal or beverages being provided in connection with an informational presentation or discussion of the company’s products or business?

Yes

Are the meal or beverages required under a written agreement?

No

Are the meal or beverages being provided in order to offer anyone an incentive or reward for granting the company business, favorable treatment, or any other commercial benefits?

Yes

Please Explain:

We are providing this meal to influence his decision.

Has any formal or informal "return on investment" or "ROI" analysis been conducted with respect to providing the meal or beverages and any resulting commercial benefit for the company?

No

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

Nature and Appearance

$125.00

Please select the country where the meal or beverages will be provided.

United States

XYZ Grille

10/01/2017

Did any proposed recipient select the location of the meal or beverages?

No

Are the meal or beverages in the form of, or offered to provide or support, any of the following:
  • Attendance at a sporting or entertainment events?
  • Providing recipients with the meal or beverages where no Company representative is in attendance, including “take-out” meals or “dine & dash” programs?
  • Any activities that could be considered inappropriate, such as gambling or adult entertainment?
  • Any other expenses that violate company policies?

No

Would you hesitate or refrain from providing the meal or beverages if the media, competitors, or the public became aware of it, or criticize a competitor for providing the same or something similar?

No

Does your offering or providing the meal or beverages comply with all applicable laws or regulations, including any regulations imposed by the employer of the recipient, such as site rules or notification requirements?

Yes

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

The Recipient(s)

John Doe

Ministry of Health

Minister of Health

What is the recipient's home country?

Albania

Is he or she a government official?

Yes

Is he or she an HCP?

Yes

Is he or she an employee of a current or potential customer?

No

Does he or she have any influence over the company’s business over the next 12 months besides prescribing the company's product (e.g., awarding a tender, contract or sale, securing regulatory or other governmental action, etc.)?

No

Who identified him or her as a recipient?

Recipient's Employer

Will the recipient receive anything that is additional to, or different from, what is provided to any other recipients?

No

Will the meal or beverages be provided to, or for the benefit of, a spouse or relative of an HCP, government official, or employee of a current or potential customer, who would not otherwise independently qualify to receive the meal or beverages (e.g., as an HCP for whom the meal or beverages is appropriate)?

No

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

Structure

Have communications or financial transactions around the transaction been conducted, or are they planned to be conducted, in a manner that is secretive or not transparent? (Click the information icon for specific examples.)

No

Have communications around the transaction used any suspicious or vague code words that that do not sufficiently or accurately describe the nature of the expense or suggest that the transaction may not be appropriate? (Click the information icon for specific examples)

No

Will the meal or beverages be provided or reimbursed in any of the following ways:
  • Using money from off-the-books accounts, third-party accounts, or personal accounts of employees, or “cash desks” or “cash safes”?
  • By reimbursing employees outside of the ordinary reimbursement process for such expenses?
  • By reimbursing expenses without invoices or receipts?
  • By paying expenses directly to a government official or employee of a current or potential customer, or to a travel agency or other third party selected by those individuals?
  • In any manner different than the company's ordinary financial or approval processes or in any other way that differs from how similar expenses would be paid or reimbursed (click the information icon for specific examples)?

No

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

Additional Information

The request letter from the Minister is attached.

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

Certification

Certification completed by Parth Chanda on 05/21/17.  View certification text.

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

Analytics

Approver Comments

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.