THIS IS A PAYMENT CLAIM MADE UNDER THE CONSTRUCTION CONTRACTS ACT 2002 A PAYMENT CLAIM MADE IN RELATION TO THE FOLLOWING CONSTRUCTION CONTRACT:

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THIS IS A PAYMENT CLAIM MADE UNDER THE CONSTRUCTION CONTRACTS ACT 2002 FROM: Name (or/payee) Contact Person/Representative Address Ph Email TO: Name (Owner/Principal/PAYER) Contact Person/Representative Address Ph Email A PAYMENT CLAIM MADE IN RELATION TO THE FOLLOWING CONSTRUCTION CONTRACT: Project Location of Project Description of construction work Date of this Payment Claim Claim Period: From Payment Claim No. To Claimed Amount Inclusive of GST $ Due date for payment Bank Account Number for payment by direct credit CLAIM DETAILS: Item Trade 1 P&G 2 Demolition 3 Earthworks 5 Concrete 6 Foundations - timber 7 Foundations - concrete 8 Piling 9 Blockwork 10 Insitu walls/panels 11 Precast panels 12 Floor slab % complete Claim Paid to Date 1

13 Reinforcing (if separate) 1 Brickwork 15 16 Carpentry 17 Subfloor framing and flooring 18 Ground floor wall framing 19 Midfloor framing and flooring 20 Upperfloor wall framing 21 Roof framing and trusses 22 Carpentry sundry materials 23 Carpentry labour 2 Cladding - timber 25 Exterior wall cladding other 26 Fixings/fasteners/dpcs 27 Hardware 28 29 Insulation - under floor 30 Insulation - walls 31 Insulation - ceiling 32 33 Ceiling linings 3 Wall linings 35 Stopping 36 37 Structural steel 38 Metalwork 39 0 Joinery 1 Internal stairs 2 Internal balustrades/handrails 3 Kitchen Vanities 5 Cabinetry other 6 Interior doors 7 Exterior windows and doors 8 Garage doors/openers 9 50 Roofing & waterproofing 51 Basement tanking 52 Gutters and decks 53 Waterproofing interior wet areas 5 Roof 55 Fascia 56 Spouting & downpipes 57 58 59 Services 60 Plumbing - under floor Trade 61 Plumbing first fix 62 Plumbing second fix 63 Plumbing fittings 6 HWC/solar water heater 65 Water storage tanks 66 67 Gasfitting first fix 68 Gasfitting second fix 69 Gas Appliances 70 Fireplace and flue 71 72 Electrical - mains 73 Electrical - first fix 7 Electrical - second fix % complete Claim Paid to Date 2

75 Light fittings 76 Garden lighting 77 Electrical appliances 78 Security - dwelling 79 Security - property 80 Home automation 81 Home entertainment 82 Lift 83 8 Drainage 85 Septic tank/effluent field 86 Detention tank 87 88 Painting & decorating - interior 89 Painting & decorating - exterior 90 Specialist coatings 91 92 Tiling - interior 93 Tiling - decks 9 Tiling exterior other 95 96 Glazing/mirrors 97 98 Exterior balustrades/handrails 99 100 Flooring 101 Floor sanding/preparation 102 Flooring - timber 103 Flooring - vinyl 10 Flooring - carpet 105 106 Landscaping 107 Driveway and paving 108 Fencing 109 Retaining walls 110 Landscaping - hard 111 Landscaping - soft 112 Pool 113 11 115 116 SUBTOTAL $ $ $ $ ADD CONTRACTOR S MARGIN $ $ $ $ TOTAL BASE CONTRACT A $ $ $ $ MONETARY ALLOWANCES (Supporting documents attached) PRIME COSTS SUMS Item % complete Claim Paid to Date 1 2 3 5 6 7 8 9 10 SUBTOTAL $ $ $ $ ADD CONTRACTOR S MARGIN $ $ $ $ TOTAL PRIME COST SUMS B $ $ $ $ 3

MONETARY ALLOWANCES (Supporting documents attached) PROVISIONAL SUMS Item % complete Claim Paid to Date 1 2 3 5 6 7 8 9 $ $ $ $ 10 $ $ $ $ TOTAL PROVISIONAL SUMS C $ $ $ $ VARIATIONS (Supporting documents attached) Item % complete Claim Paid to Date V1 V2 V3 V V5 V6 V7 V8 V9 V10 SUBTOTAL $ $ $ $ ADD CONTRACTOR S MARGIN $ $ $ $ TOTAL VARIATIONS D $ $ $ $ S U M M A R Y Base A $ Prime Cost Sums B $ Provisional Sums C $ Variations D $ SUBTOTAL (excluding GST) $ Add GST $ TOTAL AMOUNT OF THIS PAYMENT CLAIM INCLUDING GST $ IMPORTANT NOTICE What is this? This notice is attached to a claim for a payment (a payment claim) under the Construction s Act 2002 (the Act). The person who sent this payment claim (the claimant) is claiming to be entitled to a payment for, or in relation to, the construction work carried out under a construction contract.

Whether that person is entitled to a payment, and how much they are entitled to, will depend on whether you have a construction contract and what you have agreed between yourselves about payments. If you haven t agreed on payments, there are default provisions in the Act. What should I do with this payment claim? You can either pay the amount claimed in the payment claim (in full) on or before the due date for payment; or if you dispute the payment claim, send the claimant a written payment schedule that complies with section 21 of the Act (a payment schedule) stating the amount you are prepared to pay instead (which could be nothing). The due date for a payment is the date agreed between you and the claimant. That due date must be set out in the payment claim. If you haven t agreed on a due date, then the Act says that a payment is due within 20 working days after the payment claim is served on you. (For the purposes of the Act, a working day is any day other than a Saturday, a Sunday, a public holiday, or any day from 2 December to 5 January.) When do I have to act? You should act promptly. Otherwise, you may lose the right to object. What if I do nothing? If you don t pay the amount claimed by the due date for payment or send a payment schedule indicating what you will pay instead, the claimant can go to court to recover the unpaid amount from you as a debt owed. In addition, the court may decide that you have to pay the claimant s costs for bringing the court case. Can I say that I will not pay, or pay less than, the claimed amount? Yes, by sending a written payment schedule. Note: If you do not send a written payment schedule, the claimant can bring court proceedings against you or refer the matter to adjudication (or both). How do I say I will not pay, or pay less than, the claimed amount? To say that you will pay nothing or indicate what you will pay instead, you must send the claimant a written payment schedule. You must indicate the amount that you are prepared to pay, which could be nothing. This amount is called the scheduled amount. If the scheduled amount is less than the claimed amount, you must explain in the payment schedule how you calculated the scheduled amount; and 5

why the scheduled amount is less than the claimed amount; and your reason or reasons for not paying the full amount claimed. Note: The written payment schedule must also state which payment claim the payment schedule relates to. Note: If you state in the payment schedule that you will pay less than the claimed amount or pay nothing at all, the claimant may refer the dispute about how much is owing for adjudication. How long do I have? You must send a payment schedule by the date agreed in the contract or, if no date was agreed, within 20 working days after the payment claim was served on you. If I say I will pay another amount instead, when do I have to pay it? You must still pay the scheduled amount by the due date for payment. What if I don t pay the scheduled amount when I say I will? If you send a payment schedule but do not pay the scheduled amount by the due date, the claimant can go to court to recover the unpaid amount from you as a debt owed or refer the matter to adjudication (or both). Note: A court may also require you to pay the claimant s costs. Advice Important: If there is anything in this notice that you do not understand or if you want advice about what to do, you should consult a lawyer immediately. 6