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

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