PSF 4a
Justification for Additional Services
Contract Number	Date Submitted
Contract Name
Consultant
Prepared By	Checked By

Time Writing
Description of Additional Service Estimate / Claim
Justification Client Request / Previously Approved
Personnel or Disbursement	Additional Services Schedule Item No*	Unit	Quantity	Rate	Amount
Total

* Rates to be obtained from Schedule of Additional Services (where applicable).

OR

Fixed Price Quote (FPQ)
Description of Additional Service Estimate
Justification Client Request
Total FPQ	% Completed	Amount Claimed

NZ Transport Agency Use Only
Approved	Date	/ /