APPLICATION AND CERTIFICATE FOR FINAL PAYMENT

TO:

FROM:

CONTRACT FOR: CHURCH/SCHOOL BUILDING/COMMUNITY CENTER/ (OTHERS SPECIFY)______________________________

PLACE: __________________________ DISTRICT____________________STATE:___________________________________________

PROJECT NO: ________ CONTRACT AGREEMENT DATE: ________________BUILDING COMPLETION DATE:______________

CONTRACTOR’S APPLICATION FOR FINAL PAYMENT

Application is made for the final payment, as shown below, in connection with the Contract for the above mentioned building project:

1. ORIGINAL CONTRACT AMOUNT Rs.__________________

2. NET CHANGE BY CHANGE ORDER Rs.__________________

3. CONTRACT AMOUNT TO DATE Rs.__________________

4. DEDUCTIONS

a. Retainage ______ % on completed work Rs. _____________

b. Material Supplied if any Rs. _____________

c. TDS @ 2.04% Rs. _____________

d. Previous Bills payement/advances Rs. _____________

TOTAL DEDUCTIONS Rs.__________________

5. CURRENT PAYMENT DUE Rs.__________________

6. BALANCE TO PAY AFTER COMPLETION,

INCLUDING RETAINAGE Rs. __________________

The undersigned Contractor certifies that to the best of the Contractor’s knowledge, information and belief the Work covered by this application
for payment has been completed in accordance with the contract documents, that all amounts have been paid by the Contractor for the work for
which previous certificates for payment were issued and payments received from the OWNER, and that current payment(final bill) shown herein
is now due.

CONTRACTOR

Signed by:______________________________________ Date:_________________

ENGINEER’S CERTIFICATE FOR PAYMENT

In accordance with the Contract Documents based on on-site verification of the data comprising this application, the Engineer in –charge certifies
to the OWNER that to the best of the Engineer ‘s knowledge, information and belief, the Work has progressed/completed as indicated and that
the quality of the Work is in accordance with the Contract Documents and the Contractor is entitled to payment of the AMOUNT CERTIFIED.

AMOUNT CERTIFIED ________________________________________________________________________________________

____________________________________________________________________________________________________

ENGINEER IN-CHARGE

Signed by:______________________________________ Date:________________

Note: This certificate is not negotiable. THE AMOUNT CERTIFIED is payable only to the contractor named herein. Issuance, payment, and
acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract.