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(Project NAME)

CONTRACTOR: DATE:
CONTRACT NO.: Payment Application NO.:
DESCRIPTION:

PAYMENT APPLICATION # 1

Previously Total to Date This Certificate

1 Total Work Completed


2 Variation

3 Subtotal 0.00 0.00 0.00

4 Less : Retention (...% of Line 3) 0.00 0.00 0.00


5 Repayment of Retention 0.00 0.00 0.00

c Materials on Site 0.00 0.00

6 Subtotal 0.00 0.00 0.00


7 VAT 15% 0.00 0.00 0.00

8 Advance Payment 0.00


9 Repayment of Advance 0.00 0.00 0.00

10 Reimbursement 0.00

11 Amount Payable to Contractor - - -

9 Amount to be paid in $ -

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