Certificate No.

PAYMENT CERTIFICATE - PROJECTS

PROJECT NAME

PAYMENT APPLICATION DETAILS

Payment Application No. Value Submission Date Contractual Payment Due Date Period Covered

Payment Type

Advance Payment

Interim Payment

Final Payment

CONTRACT DETAILS
CONTRACT ID JOB ID CONTRACT TYPE CONTRACTOR CONSULTANT

BUDGET REF

SCOPE OF WORK :

CONTRACT DURATION

COMMITTED COST Contract Value Approved Variations Anticipated Variations Claims (EOT)

CURRENCY

Commencement Date Completion Date Revised Completion Date Actual Completion Date
Insurance Contractor's All Risk Insurance Third Party / Public Liability Workman's compensation Insurance Plant & machinery Insurance Professional Indemnity Insurance BONDS Bond Value Expiry Date Bank Policy Value Expiry Date

0 0 0 0 0 0

Estimated Cost To Complete Delay Damages

Forecast Cost To Date

CONTRACT VALUE Original Contract value Approved Variations

0.00 0.00

Advance Performance Retention Other

0.00 0.00 0.00 0.00

Revised Contract Value PAYMENT DETAILS

LAST PERIOD THIS PERIOD

0.00

CUMULATIVE

CURRENT VALUATION OF WORKS DONE

1 2 3 4 5 6 A 8

Gross Valuation of Work Done Materials on Site Variation Orders (APPROVED) Variation Orders (PENDING) Advance Payment @ % [Of Original Contract Value] General Taxes [ If Applicable]
TOTAL (VALUATION OF WORKS DONE) TO DATE

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Retention (%) Recovery of Advance Payment (%) Liquidated Damages WHT (%) [ if Applicable] TOTAL (DEDUCTIONS) TO DATE Release of Retention Total Previous Interim Payments Total Other Payments TOTAL (PAYMENTS MADE TO DATE)

DEDUCTIONS

9 10 12 B 13 14 15 C

NET PAYMENT DUE IN THE PERIOD FOR THIS PAYMENT CERTIFICATE (A-B-C)
We certify that the above mentioned amount is accurate and in accordance with Conditions of Contract

PROJECT MANAGEMENT CONSULTANT

NAME TITLE DATE SIGN. & STAMP

QATARI DIAR COST ENGINEER

NAME TITLE SIGNATURE DATE

DOA (TECHNICAL) TEAM LEADER

NAME DATE SIGNATURE NAME TITLE DATE SIGNATURE NAME TITLE DATE

DOA (FINANCIAL)

SIGNATURE

Certified Amount
DOA Matrix

DOA Technical
Project Director Group Leader DCEO Operations

DOA Financial
Corporate Financial Reporting Director CFO CFO

Less than 2 Million QAR 2 Million Upto 5 Million QAR Above 5 Million QAR