Form 3 - Certificate Of Completion Template

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Form 3
Builders Lien Act
(Section 7 (10))
Certificate of Completion
I name of payment certifier, of address, British Columbia certify that, for the purposes of the
Builders'
Lien
Act,
the
following
contract
or
subcontract
was
completed
on
_____________________,20__.
Street address or other description of the land affected by the improvement:
t
Brief description of the improvement: t
Brief description of the contract or subcontract, including the date of the contract and the names
of the parties to it: t
Signed:
Payment Certifier
Dated:
_____________________, 20__.
D/PMT/302941.1

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