Statement of Compliance Form
A statement of compliance form is a statement for acknowledgement of payment for availing a certain kind of service from an organization or a contractor. The statement of compliance form acts as an evidence that the payment was under the supervision of a higher authority.
Sample Statement of Compliance Form:
Number of the payroll: ________
Date of payroll payment: __________
Contract number: _____________
Dated: ___________
Signatory party details:
Name: First name: ________ Middle name: _________ Surname: ________
Designation: _______________
I, _____________ (name of Signatory) would like to declare that I paid the person sent by ____________ (name of the contractor) for the ________________ (details of work).
The payroll period begins on ____________________ and ends on ____________________.
All the laborers have received their wages in full. The deductions have been made as per the Wages Act.
a) Fringe benefits paid in cash ____________
b) Fringe benefits as per plans and programs ____________
__________________ Dated: __________
Signature of signatory
____________________ Dated: __________
Signature of contractor
Category: Statement Forms
