NUMBER Z01-X06

REV. NO. 0
ENGINEERING STANDARD DATE SEP 2000
PAGE 1 OF 2

Waiver Request Form

This document is issued by Engineering Standards Section, SABIC R&D Complex, PO Box 42503, Riyadh 11551, Kingdom of Saudi Arabia.
The information contained in this document is the confidential property of SABIC. It can not be disclosed, copied or used for any purpose
without prior approval from SABIC If you are not authorized to posses this document please destroy it immediately
 NUMBER Z01-X06
REV. NO. 0
Waiver Request Form
DATE SEP 2000
ENGINEERING STANDARD PAGE 2 OF 2

1. Scope
This form shall be used in conjunction with SES Z01-G06. Details and related documents shall be attached
to this form, referring to respective section(s).

Requester Reference No.:________________________________ Date: ___________________________

Contract No.: ________________________________ Job No. ___________________________________
1
Project: ________________________________________________ Affiliate: _______________________
Affected SES No.: ______________ Revision No.: ______________ Paragraph No.: ________________
SPECIFY REQUEST ____________________________________________________________________
_____________________________________________________________________________________
2
_____________________________________________________________________________________
_____________________________________________________________________________________
WAIVER IMPACTS ON __________________________________________________________________
Safety or reliability
Yes No
Acquisition or life-cycle cost Yes

No

Length of overall project schedule
Yes No
Environmental factors Yes

No

3
Compatibility with requirements
Yes No
Other(s) Yes

No

Details and Justification(s): _______________________________________________________________
_____________________________________________________________________________________
ALTERNATIVE(S) ______________________________________________________________________
4 _____________________________________________________________________________________
_____________________________________________________________________________________
REQUESTER DETAILS
5 Name:________________________________ Organization: ____________________________________
Position: ________________________________ Signature: ____________________________________

For SABIC Engineering Use Only

Waiver Request Log No.:________________________________ Date Received: ____________________

6 Additional information needed from requester Yes

No

Details: ______________________________________________________________________________
_____________________________________________________________________________________
Name: ___________________________ Signature: _____________________________ Date: _________
EVALUATION _________________________________________________________________________
_____________________________________________________________________________________
7 _____________________________________________________________________________________
_____________________________________________________________________________________
Revision of SES required Yes
No

FINAL DECISION

Rejected

Approved as is

Approved as noted
Note(s): ______________________________________________________________________________
8 _____________________________________________________________________________________
_____________________________________________________________________________________
Name: _____________________________________________ Position: __________________________
Signature: __________________________________________ Date: _____________________________