NICSI Bill Submission | Smart Fill & Print Form

BILL SUBMISSION FORM

NAME OF VENDOR:

GENERAL DETAILS
Project No.	WO/AO No.	WO/AO Date	Regular/Backdated WO
Period From	Period To	No. of Bills as per WO	Bill Count No.
No. of Manpower	Category	Milestone Based	Stage % (if milestone)

Particulars		NICSI Observations
CHECK LIST
Copy of WO & AO
Triplicate Invoices
Attendance Certificate
Proof of Payment
Short Manpower
BG Attached
Other (e.g. SNR)

INVOICE DETAILS
Invoice No.	Invoice Date	Month & Year	Bill Amount	GST	Total Amount

This is certified that:
Previous month bill(s) of this WO is not pending for payment. No claim for payment will be made against this WO for previous months.
A complete/full-service bill for the month is submitted & paid.

Name:

Email Id:

Mobile No.:

Signature & Stamp:

For Office Use

Bill Amount		Penalty
OM %		TDS
Service Tax		Net Amount
Total Amount:		Signature DM (Account)