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KO Form Pty Ltd has submitted a payment claim (PC-004) under the Building and Construction Industry Security of Payment Act 1999 (NSW) for a total amount of $152,900.00, with a payment due date of 10 July 2025. The claim details work completed on the project site at 50 Railway Parade, Marrickville NSW, including various formwork and concrete placement tasks. Supporting documentation includes delivery dockets and inspection approvals to substantiate the claim.

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Eljoy Agsamosam
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11 views2 pages

Mock

KO Form Pty Ltd has submitted a payment claim (PC-004) under the Building and Construction Industry Security of Payment Act 1999 (NSW) for a total amount of $152,900.00, with a payment due date of 10 July 2025. The claim details work completed on the project site at 50 Railway Parade, Marrickville NSW, including various formwork and concrete placement tasks. Supporting documentation includes delivery dockets and inspection approvals to substantiate the claim.

Uploaded by

Eljoy Agsamosam
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Payment Claim

(Under the Building and Construction Industry Security of Payment Act 1999 (NSW))

Claimant Details
KO Form Pty Ltd
ABN: 12 345 678 910
Unit 2, 15 Industrial Ave, Sydney, NSW 2000
Email: [email protected]
Phone: (02) 1234 5678

Respondent Details
MainBuild Constructions Pty Ltd
ABN: 98 765 432 101
50 Railway Parade, Marrickville NSW

Claim Information
Claim No.: PC-004
Date of Claim: 24 June 2025
Reference Contract: Subcontract Agreement – KO Form Pty Ltd & MainBuild Constructions
Pty Ltd
Project Site: 50 Railway Parade, Marrickville NSW
Date for Payment: 10 July 2025
Total Amount Claimed (incl. GST): $152,900.00

Schedule of Work Completed


Item No. Description of Quantity Unit Rate (ex. Amount (ex.
Work GST) GST)
1 Formwork 400 m² $85.00 $34,000.00
supply and
install – L1
suspended slab
2 Formwork 410 m² $85.00 $34,850.00
supply and
install – L2
suspended slab
3 Formwork 65 m³ $210.00 $13,650.00
supply and
install – L3
beams &
columns
4 Formwork Lump sum — $7,500.00
dismantle &
cleaning – L1 &
L2
5 Concrete 2 days $1,200.00/day $2,400.00
placement
supervision –
L2, L3
6 Retention (5%) — — -$4,115.00

Subtotal (ex. GST): $88,285.00

GST (10%): $8,828.50

Total Claimed This Period: $97,113.50

Progress Summary
Period Previous Claims (Ex. This Claim (Ex. GST) Cumulative Total
GST) (Ex. GST)
PC-001 to PC-003 $55,000.00 $88,285.00 $143,285.00

Supporting Documentation
- Concrete delivery docket – Hanson, Docket No. HN-448312 (Dated 10 June 2025)

- Formwork materials delivery docket – DOKA, Ref. 220615-KO (Dated 5 June 2025)

- Engineer’s Inspection – L2 Slab Steel Fixing Approval (Dated 12 June 2025)

- Site Supervisor Progress Photos – Levels 1–3 (Attached)

- On-site log for concrete placement crew – 13–14 June 2025

Declaration
This is a payment claim made under the Building and Construction Industry Security of
Payment Act 1999 (NSW).

__________________________
John Davis
Project Manager
KO Form Pty Ltd

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