Waiver Rate Reporting Form
Report waiver activity, reasons, and approval details for compliance and review purposes.
Reporting Period
*
Please Select
Q1 (Jan-Mar)
Q2 (Apr-Jun)
Q3 (Jul-Sep)
Q4 (Oct-Dec)
Full Year
Department or Business Unit
*
Please Select
Finance
Operations
Sales
Customer Service
Compliance
Other
Waiver Type
*
Please Select
Fee Waiver
Policy Waiver
Deadline Waiver
Contractual Waiver
Other
Number of Waivers Granted
*
Total Number of Requests Received
*
Waiver Rate (%)
Primary Reason for Waivers
*
Please Select
Customer Hardship
System Error
Policy Exception
Manager Discretion
Other
Describe the Circumstances or Details for Waivers Granted
Name of Approval Authority
*
First Name
Last Name
Supporting Documentation (if any)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Your Name (Person Completing This Report)
*
First Name
Last Name
Your Email Address
*
example@example.com
Additional Comments or Explanations
Signature of Reporting Person
*
Submit Report
Submit Report
Should be Empty: