Exception Template v4 ~ Under Review

Advance Approval for Sourcing in Exceptional Circumstances
Description of Request:*

Provide a brief description of the request in 200 characters or less0/200
Business Context:*
Exceptional Circumstance Type:*
Exceptional circumstances type text (Hidden):
Statement of Arrangement
I can confirm that:
A Competitive process was undertaken i.e. three quotes were sought or price benchmarking and market testing were undertaken.*

YesNo
Please outline the reasons for not seeking three quotes:*
Submitter Details
Submitter Full Name:*

First NameLast Name
Submitter Email:*

Confirmation EmailEnter your current work email address in both fields above.
Supplier Name:*
Enter the full Supplier Name.
Total Spend / Contract Value exclusive of VAT:*
VAT Rate:*
Select the VAT rate associated with this Exception Event
Total Spend / Contract Value formatted (Hidden):
Total Spend / Contract Value formatted incl. VAT (Hidden):
The Total Spend / Contract Value (incl. VAT) for this Advance Approval for Sourcing in Exceptional Circumstances will be €{totalSpend153}.
NFRs Approval Type (Hidden):
General Ledger Categories:*
Spend / Contract Start Date:*

DayMonthYear
Enter Spend / Contract Start Date.
Spend / Contract End Date:*

DayMonthYear
Enter Spend / Contract End Date.
Exception Event Term (Hidden):
Budget Holder Name:*

First NameLast Name
Budget Holder Title:*
Enter the Budget Holder's current Title.
Budget Holder Email:*

Confirmation EmailEnter Budget Holder's Email. You will need to confirm this email in both fields in order to progress this submission.
Health Region/National Service Area:
Enter the Full Health Region/National Service Area associated with this Exception Event
Health Region/National Service Area - if Other:
Enter your Full Health Region/National Service Area if not available in dropdown above.

Start ~ Reviewer Details Section
Approver Details

Your Total Contract Value entered into this Advance Approval for Sourcing in Exceptional Circumstances (incl. VAT) request is €{totalSpend153}. The form must be signed off at a minimum by the relevant General Manager or equivalant grade for the service making the purchase. For purchases exceeding the expenditure band and approval levels of a General Manager, the form must be signed off by the relevant grade in accordance with NFR B-1 section 4.5 Expenditure Bands and approval levels.

This request will go to the identified Approver for Review seeking Approval of this submission.
Approver Full Name:*

First NameLast Name
Approver Email:*

Confirmation EmailEnter the current work email address in both fields above for the associated Approver for this request in accordance with the NFRs B-1.
Final approval is required by CHO Chief Officer / Hospital Group CEO / Regional Executive Officer / National Director

End ~ Reviewer Details Section

Start ~ Review Section
Approver review

As the nominated Approver & under the National Financial Regulations (NFRs) - B1, by Approving/Declining this submission you are confirming that you have reviewed the information submitted.
Approver Digital Sign-Off:*
As the nominated Approver, please type your name in this field
Approver Review Date:*

DayMonthYear
Please Select Date of Review of this Advance Approval for Sourcing in Exceptional Circumstances Submission by you as the nominated Approver.
Approver Approve/Decline:*
Select Approve/Decline
Do you want to provide reasoning to the Requester for your Decline?*
If Yes, detail of Reason will be sent to the Requester via email
Approver Reason for Decline:*
Detail reason for Decline
Final Approver Details

Final approval is required by CHO Chief Officer / Hospital Group CEO / Regional Executive Officer / National Director
Final Approver Full Name:*

First NameLast Name
Final Approver Grade*
Select the grade of the identified Final Approver
Final Approver Email:*

Confirmation EmailEnter the current work email address in both fields above for the associated Final Approver for this request in accordance with the NFRs B-1.

End ~ Review Section

Start ~ Approval Section
{finalApprover159} Approval

As the nominated Final Approver, {finalApprover159}, & under the National Financial Regulations (NFRs) - B1, by Approving/Declining this submission you are confirming that you have reviewed the information submitted.
Final Approver Digital Sign-Off:*
As the nominated Final Approver, please type your name in this field
Final Approver Review Date:*

DayMonthYear
Please Select Date of Review of this Advance Approval for Sourcing in Exceptional Circumstances Submission by you as the nominated Final Approver.
Final Approver Approve/Decline:*
Select Approve/Decline
Do you want to provide reasoning to the Requester for your Decline?*
If Yes, detail of Reason will be sent to the Requester via email
Final Approver Reason for Decline:*
Detail reason for Decline

End ~ Approval Section
Final Approver Grade (Hidden)
Should be Empty:

Advance Approval for Sourcing in Exceptional Circumstances