Interim Payment Application

A. Project :

B. Employer :

C. Contractor :

D. Contract Sum :

E. Date of Valuation :

F. Progress Bill No :

We forward herewith Bill No XX For the work done up to XXX 2015 on the above project, and request an interim certificate be issued
for an amount of Rs Sri Lankan Rupees XXXXXXXXXXXXX

1.0 Total value of work done as per Contract SLR

ADD
2.0 80 % of value of material at site SLR

3.0 Price escalations SLR

4.0 Variations
4.1 Additions SLR

4.2 Omissions SLR

4.5 Net variations SLR

5.0 Other additions if any SLR

6.0 SUB TOTAL ( I ) SLR

7.0 LESS
7.1 Foreign component if any SLR

7.2 Bank Charges SLR

8.0 SUB TOTAL ( II ) SLR -

LESS
9.0 Advance recovery on 25% on work done SLR

10.0 10 % Retention on ( 6 ) above SLR -

11.0 Amounts previously certified SLR

(Payment Certificate No.X to No .XX)

12.0 Other deductions if any SLR

13.0 Total deductions SLR -

14.0 Gross amount due SLR -

on this bill ( Above ( 8 ) - ( 13 ) excluding VAT )

In Words :
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
..
Contractor