FORM 27-A-Contd.
III. CERTIFICATES AND SIGNATURES
I,…………………………………………………………………………….have satisfied myself by that the value of work done up
to date excluding the measured up additions and alternations is not less that Rs………………………………………
Conformably with the contractor’s agreement and that with the exception of authorized additions and
alternations the work has been done according to the prescribed drawing and specification.
The detailed measurement of authorized additions and alternations up to date were made by
………………………………………………………………………………………….and are accorded at page ……………… to ……………..
of Measurement Book No……………………………..
Certified that the plus quantities of materials shown in column 3 of Account II above have actually been
brought by the contractor to the site of the work and the contractor has not previously received any
advance of their security (2) that those materials are of imperishable nature and are all required for use on
the work for which a lump sum for finished work has been agreed upon and (3) that a formal agreement
signed and executed by the contractor in accordance with paragraph 10.2.24 (a) of the central P.W.A. code is
recorded in the Divisional office.
Signature of contractor
Dated Signature & Verified (…………………………………………………..
Preparing the bill Rank…………………………………………)
Pay Rs. (…………………………………………………………………………………………………………………………………………………. only)
Dated Signature of office (……………………………………………….
Authorizing Payment Rank ………………………………..……...)
IV-ACQUITTANCE
Received (Rs………………………………………………………………………………………………………………………………………...)as an
intermediate payment in connection with the contractor referred to above.
Stamp
S Witness Full signature of Contractor
Cash paid by me …………………………………………………………………………………………………………………..Dated
Cheque No……………………………………………………………………..
Dated Signature of the person {……………………………………………………….
Actually making the payment Rank…………………………………………………}
. Here specify the method employed for estimating the value of work.
. Here specify the net amount payable vide item 8 of Account I. The Payee’s acknowledgement should be
for the gross amount paid as per
. Payment should be attested by some known person when the payee’s acknowledgement is given by mark
seal or thumb impression.