PAYMENT CLAIM APPLICATION

To 27 - The Oman Construction Company (TOCO) LLC Payment Application No. :

P.O Box,142 - Postal Code 100 Date :
Sultanate Of Oman Client's Ref :
Our Ref : SO/JOB :
ATTN : Mr. Jayasheela Shetty Quote Ref :
Site Manager Location :
Project Details :
Req : For PAYMENT CERTIFICATE

Currency OMR
Prev. Current.
Estimated Estimated Current invoice
Line No. SOR ref. DESCRIPTION Unit Price UOM Invoiced Invoice Total VOWD
QTY Amount amount
Actual QTY Actual QTY

01 0.000

02 0.000

0.000

0.000

0.000

0.000

0.000

0.000

0.000

0.000

0.000

0.000

TOTAL AMOUNT OMR 0.000

Rial Omani : XXX Thousand XXX Hundred XXX and 000/1000 only

Payment Terms:

Attachments : 01 Acknowledgement :
02 Name :
03 Date :
04 AI no :
GSM no. :

Prepared By : Authorized Signatory :

KR/PCA-1/Rev.0