Sample Variation Form

Variations Approval Request Form

Project: Variation Summary No.:

Principal: PCG No.:
Contractor: Date:
Project Manager:

AGREED CONTINGENCY: $ -
VARIATIONS APPROVED TO DATE: $ -
ADD THIS VARIATION SUMMARY No. $ -
REMAINING CONTINGENCY: $ -
Recommended Variations (For PCG Endorsement and DH Formal Approval)
Variation No. Site Variation Variation Variation Variation PCG
(VARQT) Inst. Title Description Estimate Recommended Rec
No. (SI)

$
TOTALS: - $ -
Pending Variations (For PCG ‘In-principle’ approval)
Variation No. Site Variation Variation Variation Variation PCG
(VARQT) Inst. Title Description Estimate Recommended Rec
No. (SI) (Upper Limit)

$
TOTALS: - $ -
Capital Projects & Service Planning Approval
Project Manager: Signed:
Date:
Director, Capital Projects and Service Planning
Authorised by: Signed:
Date:
Reviewed and Recommended in PCG Number: PCG Date:
Note: All amounts exclude GST