FORM OF APPLICATION FOR WITHDRAWAL OF SECURITY MONEY

1. Name of Contractor :

2. Name of Work :

3. Agreement No. & Date :

4. Date of Commencement of Work :

5. Contract date or extended date of completion :

6. Work Order No. & Date :

7. Actual Date of Completion :

8. Value of Contract :

9. Estimated Value :

10. Reference to Vr. No Page No. M.B No. -

11. Whether the Work was executed shortly in

accordance with specification terms &
condition of the agreement :

12. Whether any defect have been noted after

the completion of the work :

13. Whether there is any cost of dues outstanding

against the contract in respect of the above
issued, service tendered or other recovery
remaining to be made :

14. Details of security deposit received from the

contractor
(a) Earnest money ...........................................................................
(b) Initial security ............................................................................

15. Deduction from bill 1st R.A Bill.....................................

2nd R.A Bill..................................
3rd R.A Bill.......................................

Sign. of the Contractor

Sign. of the Asstt. Engineer.

Sign. of the Executive Engineer

 NO DEMAND CERTIFICATE
(TO BE ISSUED BY CONTRACTOR)

NAME OF PACKAGE/CONTRACT :

LETTER OF AWARD/CONTRACT NO :

NAME & ADDRESS OF CONTRACTOR :

POWER STATION : TTPS

We, M/s............................................................. (Contractor) do hereby acknowledge and confirm that we

have received the full and final payment due payable to us from TVNL in respect of our aforesaid
LOA/Contract No...................................... Dated......................... including amendments, if any issued by
TVNL to our entire satisfaction and we further confirm that we have no claim whatsoever pending with
TVNL under the said contract.

Notwithstanding any protest recorded by us in any correspondence, document measurement books

and/or final bills etc. we waive off all our rights to lodge any claim or protest in future under this
contract.

We are issuing this "NO DEMAND CERTIFICATE" in favour of TVNL with full knowledge and with our free
consent without any undue influence, misrepresentation, correction etc.

Signature.........................

Name...............................

Designation......................

Date.......................

Place.........................

.....................................................

(Company common seal)