Company Name
Sub Contractor
Trade
Sub Contractor's Payment Certificate
WO / LPO No. Invoice No Invoice Date
DD/MM/YYYY
Job No: xxxx
A/C
PCF No:
Project : xxxx
Period Ending
DD/MM/YYYY
Date of Certi.
DD/MM/YYYY
Summary of Payments Value of Variations
Original Contract Value
70,795.00 Cumulative Value Certified
Retention @ 10%
570,412.50
57,041.25
Revised Contract Value
Others
1,086,794.00
-
Previous Payments done to the subcontractor
Previously Certified
Period Ending
Certified Amount
Amount Due for this month
Cumulative Amount Certified
Date of Certification
87,216.75 Details of Previous Payments Done to the Subcontractor
1.00
1 20/7/2008
55,776.60
55,776.60
2.00
2 15/9/2008
39,063.60
94,840.20
3.00
3 15/12/2008
12,105.00
106,945.20
4.00
4 15/01/2009
49,619.70
156,564.90
01/09/08 5/1/2009 16/10/08 1/2/2009 1/3/2009
5.00
5 15/02/2009
68,246.10
224,811.00
3/3/2009 31/03/09
6.00
6 15/03/2009
24,102.00
248,913.00
1/4/2009
7.00
7 15/05/2009
15,750.00
264,663.00
8.00
8 15/06/2009
44,797.50
309,460.50
1/4/2009 15/06/09 6/7/2009
9.00
9 15/08/2009
26,865.00
336,325.50 20/08/2009
10.00
10 15/10/2009
89,829.00
426,154.50
Total Certified Amount for Previous Payment
General Manager Name : Mr. -------
Payment Due
426,154.50
Project Manager Name : Mr. -----
1,015,999.00
426,154.50
473,505.00
Cerification Details Sl. No. MPA No.
Difference between original & revised Contract value
5/8/2008 PMt. Date
Amount
MPA / Chq. No.
16/9/2008
423968
55,777.0
9441322920
39,064.0
390764418
5/5/2009
12,105.00
586
49,620.00
1168
92,348.00
0
15,750.00
44,797.00 26,865.00
3/12/2009
Cumulative Payment Done Till Date
336,326.00
Out Standing Payment
177,045.25
Quantity Surveyor Name : Mr. ------
U.A.E. Dirhams Eighty Seven Thousand, Two Hundred Sixteen & Fils Seventy Five Only
