亚行货款项目提款报帐工程计量表格

支表02 Table 2 项目名称： Name of Project: 业主： Employer: 贷款编号 Loan No.: 2181-PRC

Certificate) 中 期 支 付 证 书 (Interim Payment Certificate) 承包单位： Contractor: 监理单位： Supervising Engineer: 合同号Contract No: 支付截止日期Payment Deadline: 编号No.: 金额单位 Amount Unit:人民币元 RMB 合同价及变更金额 Contract Price and Variation Amount 原合同总金额 Original Total Amount 变更增减金额 Varied Added or Deducted Amount 变更后总金额 Total Amount after Variation 到本期末完成金额 Completion Amount by the End of Current Period

章节号 Chapter No.

项目内容 Description

到上期末完成金额 Completion Amount by the end of last period

本期完成金额 Completion Amount in current period

100 200 300 400 500 600 700

总则General 路基 Subgrade 路面Pavement 桥梁与涵洞 Bridge & Culvert 隧道工程Tunnel 安全设施及预埋管线 Safety Facilities 绿化及环境保护 Landscaping & Environmental Protection 计日工Day Works 不可预见费 Contingency 小计 Subtotal 价格调整Price Adjustment 索赔金额Amount Claimed 合计Total 动员预付款Mobilization Advance Payment 扣回动员预付款Repayment of Advance payment 保留金Retention Money 违约罚金Liquidated Damages 迟付款利息Interest for Delayed Payment 支付Payment 0 0

承包单位负责人: Contractor:

总监理工程师： Resident Engineer:

业主技术负责人： Head of Eng. Dept. from Employer:

业主财务负责人： Head of Financial Dept. from Employer:

业主负责人： Employer:

支表02 Table 2

项目名称：

中 期 支 付 证 书 (Interim Payment Certificate)

承包单位：Contractor:监理单位：

Supervising Engineer:

合同号Contract No：

支付截止日期Payment Deadline:编号No.:

Name of Project: 业主：Employer:

承包单位负责人: 总监理工程师： 业主技术负责人： 业主财务负责人： 业主负责人： Contractor: Resident Engineer： Head of Eng. Dept. from Employer: Head of Financial Dept. from Employer: Employer: