PAYMENT APPLICATION

Application Ref. : Date: 15-Sep-2023

Application Type : Interim

Project Name Project Code :

Client Commencement Date
Scope Planned Completion Date
Contract/ PO Ref: EOT Granted (Days)
Contract Date Revised Completion Date
TOC Date Actual Completion Date
DLP (Days) 365 DLP Completion Date

Description Value (AED)

Contract Value :
Initial Contract Value

Sub Total A -
Variations in Original Contract
Approved Variations

Sub Total B -
Revised Contract Value
Nett Revised Contract Value -
Sub Total C -
Advance
Advance payment 30.00% AED 0.00 -
-
Sub Total -

Value of Works Executed to date

Works executed - Initial Contract Scope 50.00% AED 0.00 AED 0.00
Materials on Site -
Sub Total A (1) -
Value of Works Executed to date -Variations
Approved Variations 0.00% - -

Sub Total B (2) -

Retention
Less - Retention 5.00% - -
Release of Retention -
Sub Total C (3) -
Payments Statement
Less - Advance Payment Recovery 50.00% AED 0.00 -
Less - Previous Payments Certified
Sub Total D (4) -
Contracharges/ Others
Other Payments

Sub Total E (5) -

Total Amount = (1) + (2) + (3) + (4) + (5) (I) -

VAT @ 5% (II) -
Total Amount = (I) + (II) - Due for this Application AED 0.00

Amount in Words : UAE Dirham

Comments :

Prepared by: Verified By: Cerified By: Project Manager: Approved By: