Change Request Form for Project Management

PROJECT CHANGE REQUEST (PCR) INSTRUMENT

I. DOCUMENT CONTROL

• Effective Date: [DD/MM/YYYY]
• Document Version: [1.0]
• Jurisdiction/Scope: [Governing Law, e.g., State of Delaware]
• Reference Contract: [Master Services Agreement/SOW ID]

II. LEGAL DISCLAIMER

This Project Change Request (“PCR”) constitutes a binding amendment to the underlying Project Statement of Work (SOW). Execution of this document signifies an agreement to modify the scope, timeline, or budgetary allocation as defined herein. All provisions of the original agreement not explicitly modified by this PCR remain in full force and effect. This document is subject to internal compliance review and shall be considered an enforceable addendum upon the final signature of authorized agents.

III. PARTIES

• Client: [Full Legal Name of Client Entity]
• Service Provider: [Full Legal Name of Provider Entity]
• Project Name: [Name of Project]
• PCR ID: [Sequential Tracking Number]

IV. OPERATIVE CLAUSES

1. SCOPE DESCRIPTION The requesting party proposes the following modification(s) to the original project scope: [Detailed narrative description of the required changes, technical requirements, or deviations.]

2. IMPACT ANALYSIS The parties acknowledge the following impacts resultant from the changes described in Clause 1:

• Schedule Impact: [e.g., Extended by X days / No impact]
• Budgetary Impact: [e.g., Increase of $X.XX / Fixed Price / Neutral]
• Resource Impact: [Specific personnel or hardware requirements]

3. ACCEPTANCE CRITERIA The proposed change shall be deemed “Completed” upon the following conditions:

• [Criterion 1: e.g., UAT approval by Project Manager]
• [Criterion 2: e.g., Successful deployment to staging environment]

4. INTEGRATION & CONFLICT In the event of a conflict between the terms of this PCR and the original SOW, the terms of this PCR shall prevail solely with respect to the modifications stipulated herein. All other terms and conditions of the Master Services Agreement remain unchanged.

V. SIGNATURES & ACKNOWLEDGMENT

FOR CLIENT: Signature: __________________________ Printed Name: [Name] Title: [Title] Date: [Date]

FOR SERVICE PROVIDER: Signature: __________________________ Printed Name: [Name] Title: [Title] Date: [Date]

VI. EXECUTION GUIDE

1. Impact Assessment: Before circulation, the Service Provider must perform an internal technical audit to verify the feasibility of the changes and update the "Impact Analysis" section with quantitative data.
2. Authorization: Ensure that signatories possess valid signatory authority as defined by the corporate bylaws or the Master Services Agreement (MSA) current at the time of execution.
3. Record Retention: Once fully executed, distribute the digital copy to both the Project Management Office (PMO) and the Finance/Accounting department for immediate billing adjustments or timeline rescheduling.
4. Version Control: Archive the signed PCR as a permanent sub-folder or attachment to the parent Statement of Work to maintain an audit trail for future compliance reporting.