Contractor Payment Certificate

{{company_name}}

{{company_address}}

Phone: {{phone}} | Email: {{email}} | Web: {{website}}

Contractor Payment Certificate

Contractor Payment Certificate

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

CONTRACTOR PAYMENT CERTIFICATE

Certificate Number: {{certificate_number}}

Date of Issue: {{date_of_issue}}

Project Name: {{project_name}}

Contractor Name: {{contractor_name}}

Contractor Address: {{contractor_address}}

Contract Number: {{contract_number}}

Certification Period

Payment Period From: {{period_start_date}}

Payment Period To: {{period_end_date}}

Date of Application for Payment: {{application_date}}

Contract Value and Previous Payments

Original Contract Sum: {{original_contract_sum}}

Agreed Variations/Additions: {{variations_additions_amount}}

Revised Contract Sum: {{revised_contract_sum}}

Less: Total Amount Previously Certified: {{previous_certified_amount}}

Work Completed and Materials On-Site

Value of Work Executed to Date: {{value_work_executed}}

Value of Materials on Site (if applicable): {{value_materials_on_site}}

Gross Amount Due for this Certificate: {{gross_amount_due}}

Deductions and Withholdings

Less: Retention ({{retention_percentage}}% of Gross Amount Due): {{retention_amount}}

Less: Other Deductions (e.g., penalties, previous overpayments): {{other_deductions_amount}}

Total Deductions: {{total_deductions_amount}}

Net Payment Due

Net Amount Due for Payment (This Certificate): {{net_amount_due_this_certificate}}

Amounts in words: {{net_amount_due_words}}

Certification Statement

I hereby certify that, to the best of my knowledge and belief, the work completed and materials supplied by the contractor, {{contractor_name}}, up to {{period_end_date}}, are in accordance with the terms and conditions of Contract Number {{contract_number}} and that the amount stated above is justly due for payment.

This certificate should not be construed as acceptance of defective work or materials not in accordance with the contract documents.

Authorisation and Approval

___________________________

Authorised By: {{authorised_by_name}}

Title: {{authorised_by_title}}

Date: {{authorisation_date}}