Information
-
S/O Number
-
Address
-
Date
-
Prepared by:
Details
-
What work type was selected at scoping stage?
-
What is the new proposed work type that requires Chorus approval?
-
What is the new proposed work type that requires Chorus approval?
-
What is the new proposed work type that requires Chorus approval?
-
Detailed description to why the work type is changing
-
Photos to support comments
-
Any traffic management required?
-
How many required? B22 or B23 required?
-
Any outside boundary conditions concrete cutting required?
-
Insert picture of concrete that will require reinstatement including dimensions. Note: Please advise dispatch via email you require VPL to complete this reinstatement
-
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.
-
We will carry out the work in accordance with Chorus' End User Terms (available at www.chorus.co.nz/ufb-terms).
Outside property consent
-
Surface mounting of ruggedised on fence or wall?
-
Hole excavation and trenching?
-
Removal of concrete/tiling/pavement?
-
Installation of conduit(s)?
-
Removal of existing copper line to the house?
-
Others?
-
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.
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] -
End user signature:
-
Authorised Chorus technician:
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.