Recovery Statement - JBCC

Certificate No:Minor Works Agreement Edition March 2014 Date of Certificate:The following amounts, detailed in supplementary documentation where required, are recovered in the current Payment CertificateABCTOTAL AMOUNTLESS PREVIOUSRECOVERY TO BE RECOVEREDRECOVERYTHIS DUE TO THE by the contractor [ ]Subtotal of [ ] [ ]Subtotal of [ ] from contractor of a deposit [ ]Subtotal of [ ] DUE TO THE interest [ ] amounts paid [ ]Subtotal of [ ] [ ][ ]Currency Note: all amounts exclude tax SignatureDate:Name and address of the principal agent's practiceJBCC MWA Edition Recovery Statement March 2014 EmployerContractorRecovery StatementIssued in terms of Clause of theContractor not paying the employer an amount due [ ]Work executed by others [ ]Effecting insurances, or paying charges [CD]WorksSiteSigned by the principal agent who, as agent for the employer, certifies that the amounts stated above are included in the identified payment certificate Termination of the agreement [ ]Penalties levied [ ]Default interest [ ]

Certificate No: Minor Works Agreement Edition 5.1 © March 2014 Date of Certificate: The following amounts, detailed in supplementary documentation where required, are recovered in the current Payment Certificate

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