NO CLAIM CERTIFICATE

Project: Package:

Contractor: Date of Completion:

Address: …………………………………………………………

…………………………………………………………

Original Contract Sum

Revised Contract Sum

Cumulative Certified Amount

(incl all applicable taxes)

Deductions:

Retention @ 5%

Housekeeping ……………………………
Security Services ……………………………
Power Supply ……………………………

Others, if any ………………….…….. ……………………………

Net Cumulative Payable -

We confirm that we have no unsettled claims against Synergy Property Development Services Pvt Ltd or
the Developer and that by accepting this final payment, we acknowledge that we have no claims or any
waiving all such claims. We agree that we waive any and all lien rights on the Project effective upon
receipt of the final payment.

The undersigned contractor hereby acknowledges that the above information is correct including without
limitation the amount of final payment due, the amount of contra-charges and extra work orders, if any,
the direction to deduct any such contra-charge from final payment, the Waiver of Lien Rights upon
receipt of final payment and the acknowledgement of no claims against the Developer and Synergy
Property Development Services Pvt Ltd.

The undersigned Contractor also agrees to indemnify the Developer and Synergy Property Development
Services pvt Ltd from any liability on account of any claims by sub-contractors and/or suppliers and/or
labours from payment due for labour, material, equipment, PF, ESI, etc and any and all services provided
and to provide a Final Lien Waiver in exchange from this full and final payment.

Accepted by: ………………………………………………………..….

(Contractor's / Vendor's Name)

………………………………………………………..….
Signature of authorised rep with seal