SAMPLE OF PAYMENT CERTIFICATE

INTERIM PAYMENT CERTIFICATE NO:

PROJECT TITLE:

CONTRACT No.:

CLIENT:

CONTRACTOR:

COMPLETION DATE :

WORK DONE AS AT:

Item	Description	Amount (RM)
	Original Contract Sum (RM)	10,000,000.00
	Add/Deduct Variation Order (RM)	450,000.00
	Revised Contract Sum (RM)	10,450,000.00
	Work done as at: 27th July 2012
1	Preliminaries & General	321,892.00
2	Detailed Scope Of work. Eg: Piling Works, Building Works, Drainage	6,523,154.53
3	Material at Site ( 75% Allow)	128,156.00
4	Total Value Of work Done	6,973,202.53
5	Less: Retention ( 10% of this payment Certificate up to total of 5% of Original Contract Sum)	500,000.00
6	Less : Previous Payment No.	4,281,536.79
	Amount Payable under this certificate	2,191,665.74

Total amount payable under this interim certificate No…. is Ringgit Malaysia Two Milion One Hundred

and Ninety One Thousand and Six Hundred And Sixty Five and Cents Seventy Four Only. (RM 2,191,665.74)

Evaluation date :

Evaluate By:                                                                                                                       Agreed by:

Signature:                                                                                                                           Signature:

Name:                                                                                                                                  Name:

Position:                                                                                                                              Position: