INTERIM PAYMENT FORM NO DATED:

Contractor:
A. DETAILS OF THE PROJECT
Project: Villa Ground+1 Const.Started on:
Owners Name: Mr. Completed on:
Contract Sum Dhs. 0.00 Extention. up to:

B. PAYMENT AMOUNT
Gross Amount Certified 0.00% Dhs 0.00

DEDUCTIONS
1. Amount recd. directly from owner Dhs 0.00
2. Retention till date Dhs 0.00
3. Amount recd. from MRHE Dhs 0.00
Total deductions Dhs 0.00

Amount of this bill Dhs 0.00

Less: Retention under this bill Dhs 0.00
Amount due for payment Dhs 0.00

C. RETENTION MONEY
Previous Amount of Retention Held Dhs 0.00
Retention on this payment Dhs 0.00
Total Retention Held Dhs 0.00

D. CONTRACTOR'S CERTIFICATION
We certify that this claim is true and correct. Kindly release payment.

Signed on behalf of the Contractor

E. CONSULTANT'S CERTIFICATION
We undertake that the actual percentage of this payment is checked & certified in accordance with
the agreed schedule, specification and excuted work at site.
We are responsible for any financial & legal implications on that.

Signed on behalf of the Consultant Date:

F. OWNER'S SINGTURE Date:

(FOR Engineering Department USE ONLY)

F. MRHE File No.:

MRHE Loan A/C No.: MRHE Loan Amount: Dhs.

G. Engineering Department CERTIFICATION: We have checked the progress of work

and certify that amount of this claim is in order.
Signed on behalf of Engineering Department Date:
MRHE/QP/156/QF/06
MRHE/QP/156/QF/06