Client: (PMC) : Contractor:
Project :
Project No. :
Payment Certificate
Contract /PO Ref. :
Contract Name :
Contractor Name :
Certificate No : Certificate Type : Interim Final
For the Period Ending : Submittal Date :
INITIAL CONTRACT DATA
Original Contract Value : SAR
Approved Variations : SAR
Revised Contract Value : - SAR
PAYMENT DETAILS:
Value of Work Done A) As per Original Contract : SAR
B) As per Approved Variations : SAR
C) Material on Site (If Applicable) : SAR
D) Total Value of Works : - SAR
Less E) Recovery of Advanced Payment : % of (A+C) = SAR
F) Retentions : % of (D) = - SAR
G) Other Deductions : SAR
H) Total Deductions : - SAR
I) Total Amount Certified : (D) - (H) - SAR
J) Less Amount Previously Certified SAR
Net Amount Due - SAR
Submitted by Contractor : ……………………………………… Date : ………………………….
Approved by Const. Manager : ……………………………………… Date : ………………………….
Approved by Project Manager : ……………………………………… Date : ………………………….
Approved Manager, Projects Dept : ……………………………………… Date : ………………………….
Ref: PD.SF015R1
Date: Jan, 1st, 2011