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{{Company_Name}}

{{Project_Name}} - {{Project_ID}}

CHANGE REQUEST

Date Prepared: {{Current_Date}}	Project Manager: {{Project_Manager_Name}}

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1. Requestor Information

Requestor Name and Position: [ Add details... ]

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2. Change Classification

Change Category: - [ ] Scope - [ ] Schedule - [ ] Cost - [ ] Quality - [ ] Resource - [ ] Other: [ Add details... ]

Change Type: - [ ] Mandatory (e.g., Legal / Compliance) - [ ] Discretionary

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3. Change Details

3.1 Description of Change

[ Add details... ]

3.2 Justification for Proposed Change

[ Add details... ]

3.3 Implications of Not Making the Change

[ Add details... ]

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4. Impacts of Change

Area	Impact Type	Impact Description
Scope	[ + / - / M ]	[ Add details... ]
Quality	[ + / - / M ]	[ Add details... ]
Requirements	[ + / - / M ]	[ Add details... ]
Cost	[ + / - / M ]	[ Add details... ]
Schedule	[ + / - / M ]	[ Add details... ]
Project documents	[ + / - / M ]	[ Add details... ]

Legend: [+] Increase, [-] Decrease, [M] Modify

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5. Comments

[ Add details... ]

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Sign-off and Approvals

Role	Name	Signature	Date
Requester	{{Requester_Name}}	_______________________	[ .... - .... - .... ]
Project Manager	{{Project_Manager_Name}}	_______________________	[ .... - .... - .... ]
Change Control Board (CCB) Chair	{{CCB_Chair_Name}}	_______________________	[ .... - .... - .... ]
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Electronic Audit Trail: Hash SHA256: {{Audit_Trail_SHA256_Hash}}
Template: CHANGE REQUEST | Ref: PMO-05.03
Generated on: {{Current_Timestamp}}, by Tasleemat