Singh Construction Company

Engineers & Contractors

SUBCONTRACTOR CLEARANCE FORM
(To all the HOD’s – necessary clearance remarks to be entered against your department and to be signed
by the concerned HOD to enable to process the full and final settlement of the Petty Contractor)

NAME OF CONTRACTOR : _____________________________________________________

PETTY CONT. CODE : _____________________________________________________
PROJECT : _____________________________________________________
_____________________________________________________

Sr.No Description Remarks Dues if any Signature

A) PROJECT/SITE IN CHARGE Name:……………..

(All property, material, documents,
information and related tools, equipments
handed over by the Contractor. Proper notice Signature:………………
period given and worked till the last date) .

B) STORE INCHARGE Name:……………..

(All store goods, material issued to the
Contractor received back, account reconciled) Signature:………………
.

C) ACCOUNTS DEPARTMENT Name:……………..

(Any advance, lone amount pending from the
Petty Contractor) Signature:………………
.
D)
ADMINISTRATION DEPARTMENT Name:……………..
(All capital goods issued the Contractor are
received back) Signature:………………
.
E)
OTHERS: Name:……………..
1. Labour clearance
2. Any other Liabilities Signature:………………
.

Full and final settlement of Contractor to be made.

For Singh Construction Company

Authorized Signatory.
Signature of Conatractor
Note: All necessary document should be enclosed as above