HGCRA Pro Forma

Interim Payment Application Form

A blank, ready-to-complete interim payment application. Set out the valuation, apply retention, state the net sum due, and record the HGCRA payment and pay-less dates so your application stands as the notified sum.

1 · Application details

Project name

Full project name as stated in the subcontract

Subcontract / contract reference

Exactly as it appears in the subcontract

Application number

Sequential — e.g. AFP-014

Application / valuation date

DD/MM/YYYY — the due date for this cycle

From — applying party

Company, contact name and role

To — paying party / contractor

As named in the subcontract

Period / cycle covered

e.g. valuation period 14 — to DD/MM/YYYY

Valuation reference

If a separate valuation number is used

2 · Payment dates (HGCRA)

Due date

As defined by the payment mechanism

Final date for payment

DD/MM/YYYY — typically 14-21 days from due date

Payment notice due by

Not later than 5 days after the due date

Under the HGCRA, the payer must issue a payment notice within 5 days of the due date stating the sum it considers due. If it does not, this application stands as the notified sum and becomes payable in full unless a valid pay-less notice is served before the final date for payment.

3 · Valuation of the works

Gross value of work done to date

£ — measured and completed work

Value of variations / change

£ — agreed and notified variations

Materials on/off site

£ — where the contract allows

Gross valuation total

£ sum of the above

Less retention

£ — state the percentage applied

Net valuation

£ gross less retention

Basis of valuation

How the figures were measured — reference the priced activity schedule, bill of quantities, or rates

4 · Sum applied for

Net valuation this period

£ from section 3

Less amounts previously certified / paid

£ cumulative to date

Net amount now applied for

£ — the notified sum (excl. VAT)

VAT

£ — if applicable

Total amount now due (incl. VAT)

5 · Retention

Retention percentage applied

% — typically 3-5%

Cumulative retention held

£ total withheld to date

Retention release due

DD/MM/YYYY — at completion / defects

6 · Supporting documents attached

Valuation / measure

Variation account

Materials invoices

Programme / progress record

Photographs

Other (list below)

Documents list

Itemise the documents that evidence this application

7 · Submitted by

Signed

Name and position

Date

DD/MM/YYYY

8 · Payer use — payment notice / pay-less reference

Payment notice issued — sum considered due agreed

Pay-less notice to follow — see separate notice

Sum the payer considers due

£ — if different from applied sum

Payment notice date

DD/MM/YYYY

Reference

Payer's internal reference

How to use this form

1
Complete section 1 with a sequential application number and the dates for this valuation cycle.
2
Record the HGCRA dates in section 2 — the due date, the final date for payment, and the date by which the payer must issue a payment notice.
3
Build up the valuation in section 3 and carry the net figure into the sum applied for in section 4 — this is your notified sum.
4
Keep the supporting documents listed in section 6 with the application; a well-evidenced application is harder to pay less against.
5
Serve the application, keep proof of service, and diarise the payment-notice and pay-less deadlines — if the payer misses them, the notified sum becomes payable in full.

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