Variation Request Form

• Site conducted

  Select

• Australseal Protective Solutions PL - ABN:68633653362 - admin@aspsau.com - 0448944893

• Location:
  Address

• Conducted on:

  Date

• Prepared by:

• Client Name:

• Reason for Variation

  Select Damaged Membrane Additional Works Time Constraints (requested overtime hours) Other: Material Change Design Change

  • Damaged Membrane
  • Additional Works
  • Time Constraints (requested overtime hours)
  • Other:
  • Material Change
  • Design Change

• If other has been selected, please provide reason why this variation is required:

• Project Name (Include project no)

• Manufacturer & Material(s) Used:

• Area(s) Completed:

• Amount of Material or Hours Used or completed

• Total amount chargeable excluding GST

Submission origin:

• E.g: Onsite / Offsite

  Onsite

  Offsite

Activity

• Provide a minimum of 4 photos of area(s) completed:

  Media
Final Inspection

• Client Name & Signature:

  Sign

• Date:

  Date

• Australseal Representative Name & Signature:

  Sign

• Date:

  Date

• This Variation Request Form is used to identify additional areas to complete as a request by client. Australseal Protective Solutions Pty Ltd will use this form to submit part of our progressive claim cycle as per contract requirements and protected with Security Of Payments Act NSW 1999 together with The Building and Construction Industry Security of Payment Act 2002

• Photo 1

  Media

• Photo 2

  Media

• Photo 3

  Media

• Photo 4

  Media