Payment Claim Form
ADVERTISEMENT
1
2PAYMENT CLAIM
THIS IS A PAYMENT CLAIM UNDER THE CONSTRUCTION CONTRACTS ACT 2002
REVERSE
IF YOU ARE A “RESIDENTIAL OCCUPIER” PLEASE READ THE NOTICE ON THE
Company/Name
Company/Name
Address
Address
Attention
Contact
Project
Trade
Site Location
Our Ref
Payment
Claim
Due date
Last date for
/
/
/
/
/
/
/
/
Claim No
Period
for payment
submitting claim
From
To
Fold
Claim to Date
Item
Description
Qty
Rate
Total
%
$
TOTAL BASE CONTRACT
$
$
(A)
Submit
Approved
Variation
Claim to Date
Var No
Description
Date
Date
Var Ref
Amount
%
$
Fold
TOTAL VARIATIONS
$
$
(B)
New Zealand Contractors'
Total Base Contract Complete to Date
Insert Total A
$
Federation
Total Variations Complete to Date
Insert Total B
$
The New Zealand Building
(C)
Gross Claim to Date
A + B
$
Subcontractors' Federation Inc.
(D)
Less Retention (if applicable)
$
(E)
Net Claim to Date
C - D
$
(F)
Less Previous Net Claimed Amount Total ‘E’ from last claim
$
CLAIMED AMOUNT (excluding GST)
E - F
$
Form Ref PC1.2 Rev Mar 2003
To Reorder contact Forms Control Ltd, Ph: 09 570 2272, Email: orders@formscontrol.co.nz, Web:
Original Copy - Green, File Copy - White, Accounts Copy - Pink
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal