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Issue No.

01
CONS/CVI/22 FORMS/RECORDS
Rev. No 00
FORM22: CONFIRMATION OF VERBAL INSTRUCTION
Date: CVI No.

Project Name

Confirmation required by

Name Designation

Company Date Confirmation required

DETAILS OF INSTRUCTION

Instruction Given to: Date Instruction was Given:

Related Drawing Ref. Location of tasks:

Details of Instruction:

Related Cost Implication? Yes No Variation Order No……..

Related Time Implication? Yes No Extension of Time……….

Related change in Drawing/Design? Yes No New Drawing No. ………..

CONFIRMATION REQUESTED BY

NAME DESIGNATION

SIGNATURE DATE
CONSULTANT TO COMPLETE
NAME DESIGNATION

CONFIRMATION APPROVED CONFIRMATION NOT APPROVED

REMARKS:

SIGNATURE: DATE:

CC to Client M&E Engineer QS


Architect Structural Engineer Other: ………….

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IC: PAD/CONS/01

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