Issued by:

Job reference:

Address:

Certificate no.:

Employer:

Date of valuation:

Address:

Issue date:

Contractor:

Due date:

Address:

Final date of payment:

Name of Project:

Milestone Achieved:

This Interim Payment Certificate is issued under the terms of the

above-mentioned Contract.
Total Values of Milestone achieved

--------------------------

___________

Any claims for Additional Payments -----------------------------

___________

Sub-total

___________

Interim Payment Certificate ----------------------------------------

___________

Less total of any sums previously certified in

Less any sum payable under the Contract

by the Contractor to the Owner ----------------------------------Sub-total

___________
___________

Less reimbursement of Advance Payment -------------------

___________

Net amount for payment

___________

----------------------------------

I/We hereby certify that the amount of interim payment to be

made by the Employer to the Contractor is (state sum in words)
__________________________________________________________
__________________________________________________________

Signed ____________________________________________________
This is not a tax invoice.

Distribution

Employer
Contractor

Other recipients:
Copy on file

Distribution

Employer
Contractor

Other recipients:
Copy on file