COMPLETION OF WORK CERTIFICATE (COWC) �

BLUMONT.
I Date of Receiving: I August 1, 2021 COWC Ref. No. I iRAQ-2021-ERB-105 I
DOCUMENTS DELIVERED WITH THE GOODS PROJECT DETAILS & DELIVERY LOCATION OF GOODS
Contract Reference : Trans-EBL-019-03 Project Code: Shared
PO number In CP (if
applicable) N/A Donor Name: Shared
Supplier invoice#
(ifapplicable): N/A Project Start Date June 30, 2019
Locaton of Delivery: Erbil Project Expire Date July 31, 2021

Contract Description: Providing a vehicle with driver including fuel for Erbil office one month for July 2021

(A) IMPLEMENTED WORK

Qty on the Remiilinin1
I
No Item Description Qty Received Item Serial No. I if applicable) Unit of Meilsure REMARKS
PO/CT Qty

001 Providing a vehicle with driver including fuel for Erbil office one month for July 2021 1 1 0 Month
002

003

004

005

006

007

008

009

010

(B) ANY EXTRA WORK CARRIED BY VENDOR

Qty on the Remaining
I
No 0.00 Qty Received Item Serial No. (if applicable) 0.00 REMARKS
PO/CT Qty

001

002

003

1- (Person Physically Receiving the Goods) Blumont Represenatives

We the undersigned declare that we concur that the products & commodities listed above were determined to be in acceptable condition and as per the approved BoQ in
Contract
Received By: Certified By: Approved By:
Digitally signed by
Omar
Digitally signed by Omar Emad
DN: cn=Omar Emad, o, ou, Digitally signed by
email=oabdullha@blumont.org Hardi Ameen Mohammed Fouad
Date: 2021.08.03
Emad
, c=IQ
Date: 2021.08.01 17:54:14 Date: 2021.08.03
+03'00' 14:34:06 +03'00' 14:37:28 +03'00'
Dat�&Signaturr Dat!!&Sir,naturr Dar�&Sigriature

Name Name Name

Position: Position: Position:

Note: For any inventory or Asset item, the IT team should sign/verify the GRN as well

2- NAME OF DELIVERER (Purchaser/ Supplier)

I the deliverer is the su lier indicate the name o the com an and the name o the deliverer

VENDOR/ Company
NAME:

NAME OFs1GN ATORv, Abdulhamed

Signature & Stamp

TITLE OF SIGNATORY: DATE oF SIGNING:

NOTE:
- - L 25 2 j -- 0
All data and information mentioned/recorded in this form must be approved (si ned} through the authorized organization committee above first and then confirmed by the supplier or contractor (signed & Stamped},
otherwi� this form wilt not consider as official document.

BLUMOOT INC. ORGANIZATION COMPLETION OF WORK CERTIFICATE (COWC)