NGA - Chorus approval for work type variation - duplicate

• S/O Number

• Address

• Date

  Date

• Prepared by:

Details

• What work type was selected at scoping stage?

  1. Aerial (560)

  2. Haul (561)

  3. Surface Mount (562)

  4.Trench (563)

  5. Drill or slot Trench in Concrete (564)

• What is the new proposed work type that requires Chorus approval?

  5. Drill or Slot trench in concrete (564)

  6. Hard surface trench (565)

• What is the new proposed work type that requires Chorus approval?

  4. Trench (563)

  5. Drill or Slot trench in concrete (564)

  6. Hard Surface Trench (565)

• What is the new proposed work type that requires Chorus approval?

  6. Hard surface trenching (565)

• Detailed description to why the work type is changing

• Photos to support comments

  Media

• Any traffic management required?

  Yes

  No

• How many required? B22 or B23 required?

• Any outside boundary conditions concrete cutting required?

  Yes

  No

• Insert picture of concrete that will require reinstatement including dimensions. Note: Please advise dispatch via email you require VPL to complete this reinstatement

  Media

• Has the Customer re-consented to the new scope - If so obtain customer consent

Ultra-Fast Broadband Installation Consent

• If you are not the person who ordered service (the customer), please confirm that you are authorised to represent the customer.

  Sign

• We will carry out the work in accordance with Chorus' End User Terms (available at www.chorus.co.nz/ufb-terms).

Signed consent

• I confirm that:
  - I have seen, read and understood this information and the end user terms and accept those terms; and
  - If I am not the owner of the property, I have obtained the consent of the owner for the installation works; and
  - I understand that there may be an impact on the operation of burglar and medical alarms, particularly monitored alarms. [Note: check with your alarm provider or telecommunications service provider]

Outside property consent

• Surface mounting of ruggedised on fence or wall?

  No

  Yes

• Hole excavation and trenching?

  No

  Yes

• Removal of concrete/tiling/pavement?

  No

  Yes

• Installation of conduit(s)?

  No

  Yes

• Removal of existing copper line to the house?

  No

  Yes

• Others?

  No

  Yes

• Description of other

• Clean up: We will leave the property in a clean and tidy state on competition. This does not include reinstatement to the same condition.

• End user signature:

  Sign

• Authorised Chorus technician:

  Sign

Next step

• Once all fields have been completed this form must be submitted to your field manager and vplufbpro@visionstream.co.nz Note: Approval will given verbally by the Chorus DS to the FM this form must be submitted and the expected turn a round time from Chorus is less then 4hrs for a reply to the email.