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PAYMENT CLAIM

Claim #: CCA-001
Date served: 2026-01-01
Contract ref: CONTRACT-001

This is a payment claim served under the Construction Contracts Act 2002. The respondent must respond with a payment schedule within 20 working days of receiving this claim, or the claimed amount becomes payable in full.

Claimant (Contractor)

Your Business Name

Address

GST No: [your GST number]

Respondent (Principal / Client)

Client / Developer Name

Address

Construction Work / Services

Project name and site address

Claim Period

Work performed from [start date] to [end date]

Description of Work	Scheduled Amount ($)	% Complete	Claimed ($)
Contract work — [description]	100,000	60%	60,000
Approved Variation — VO-001	5,500	100%	5,500

Gross amount claimed$65,500

Less retention (5%)($3,275)

Less previously claimed & paid($0)

Net claim (excl. GST)$62,225

GST (15%)$9,334

AMOUNT CLAIMED$71,559

Payment Instructions

Bank: [Bank Name] | Account: [XX-XXXX-XXXXXXX-XX] | Reference: CCA-001

Claimant signature / Date

Served on (respondent) / Date received

⚖️ CCA Payment Claim

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