QATAR DESIGN CONSORTIUM

ARCHITECTS, ENGINEERS, PROJECT MANAGERS & CONSULTANTS

Ref. No: PAYMENT REQUEST AND CERTIFICATE Date:

PROJECT:
CLIENT:
CONTRACTOR:
DESCRIPTION AMOUNT
Original Contract value
Approved variation amount ( Ref & Date )
Total revised contract amount
Advance Payment
Stage of work completed:
Amount corresponding to work completed:
Deductions corresponding to Material at Site:
Recovery of advance @
Retention amount @
Amount previously certified
Total Deduction
Net amount requested
Amount in words
ENCLOSURES:
 Summary of payments received (F 328)
 Progress Report (F323 and F326 Sheet 1 to 6)
 Invoices
 Quality Test Report
CONTRACTOR’S STAMP CONTRACTOR
QDC’S REMARKS
……………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………

ENGINEER PROJECT MANAGER PROJECTS MANAGER

CLIENT’S REMARKS
Certified amount is accepted and paid by Cheque no. __________________
dated ________ drawn on _____________________________________ bank.
Certified amount is not accepted for following reasons:
________________________________________
__________________________________________________________________________

CLIENT
Note: Fax this form back after filling in the payment details for QDC records.

Doc. No: F 327 Rev. No: 02 Dated 1st February 2010 Page 1 of 1