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' lo . 2) 1972

I he eby certify that
(i) the セ。ケュ・ョエウ@
re . . er ... e to in t·
invo · ces listed be ow,
1ri_ · c · .L or c pie
f wn ich accompa.ny this payment
certificate, fal
r spect of セッョエイ」@

C..ue an

ue to be made in
••••••••••• dated .••••••••••••

セッ@

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between the co -L act r named belo; and ••••••••••••••
Pu"""chaser) and are
a. cordance :ri tn
a.I エセ」@
ars of

this c tr ct n ti ied in the contract 」・イエゥセ。@
signed on e la f ッセ@
l1e 3a · c or - -r c·- l on .•.•••••••••

ate

Contractor's
Invo'ce .o.

(ii)

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The amounto spec:..fied in

!o t descr i p ion of
s, wo_ ..c nr /or
se!'vic es

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oreis-n c o_ . . te _t to t:
alr ad. d cla.::: d in
paragr phs :, , 6 or 7 of the contract certif'i at,e .
11ic• c er i .. · c t e
l have the au.tho1 i'-y ··-o i
·o nalf of
the con tractor na::iea. Ciel ow .

additional

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2or an

on beha -· of' •••••••••••••••••••••••••••••••••••••

ame rud address of contrac or ••••••••••••••••••••••••••••••••••

te •••.•••••••••••••••.•••• • • • • • •

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or the pur ose of this declaration t e United
the Channel Islands
d vhe sle of an .
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