PROJECT: EMPLOYER: LTA/SITE CONTRACTOR:

UNDP ENGINEER:
MERP Program

POSSIBLE DELAY NOTIFICATION

From : To:
PDN ref: Contractor/Area/Year/PDN/Trade/Seq./Rev# Schedule ref:
Area: Specification ref :
Location : BOQ division ref :
Date: Material Submittal ref:
Trade:
For Contractor Use:
1. This PDN
Is in response to ---------
2. Description and Justification of PDN
Subject:
--------------------------------------------------------------------------------
3. Change Type
Design Change Specification Change Others

4. PDN Effect on Contract on Contract Schedule

 Proposed PDN impact on in Contract Schedule? No Yes Increase
Decrease

Contractor’s Representative: Signature: Date:

Attachment Type of Receipt Info

Sent To Acti No (s) Attachment(s
on Action )
Yes No Received By Date Signature

Status
LTA/SITE Engineer’s Comment:
---------------------------------------------------------------------------------------------------------------- A □
---------------------------------------------------------------------------------------------------------------- AW
---------------------------------------------------------------------------------------------------------------- C □
----------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------- RR □
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------- REJ □
----------------------------------------------------------------------------------------------------------
Name: Signature: Date:

UNDP-MERP Program
PROJECT: EMPLOYER: LTA/SITE CONTRACTOR:
UNDP ENGINEER:
MERP Program

 A: APPROVED
 AWC: APPROVED WITH
COMMENT
 RR: REVISE RESUBMIT
 REJ: REJECTED

UNDP-MERP Program