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[接上页] 执行单位合同号/订单号和签约日期 EA Contract No./PO Reference No. and Date: 亚行合同号(PCSS号): 银行代码 Bank Code: 贷款类别号 Category Refrence No. : 备注 Remarks: 仅需开发性金融机构转贷填写 For DFI Loans only: 采购国家 Counry of Procurement: 转贷款号 Subloan No.: 1、需附两份签过字的信用证。Two copies of signed L/C should be attached. 附件12: 自营工程的证明文件(第I部分和第II部分) 自营工程证明(第I部分)CERTIFICATE(PART I) FOR FORCE ACCOUNT WORKS 日期Date: 兹证明截止_________(日期)与_________有关的工程累计进度为__________% It is certified that as of____(date)______the cumulative progress on the work relating to was________%. 签字1 姓名: 职务或职称: 1、须是项目顾问或总工程师,或项目执行机构的授权代表。 自营工程证明(第II部分)CERTIFICATE(PART II)FOR FORCE ACCOUNT WORKS 亚行对此自营工程的融资额为_________美元。根据上述证明(I)所列的工程完工进度,累计应提款额为______________美元。根据到__________号为止的提款申请书的提款申请,已提用__________美元。现根据____________号提款申请书,要求提取_________美元的余额。 The amount of ADB loan allocated for financing this force account works is US$. On the basis of the percentage of work completed as certified in Part I above, the cumulative amount that could be withdrawn is US$ . An amount of US$ has already been withdrawn under withdrawal applications up to and including application No. and the balance of US$ is now requested to be withdrawn under application No.. "该自营工程的融资额为 Amount calculated for financing this force account works" 美元US$ "累计可提款金额为 Cumulative amount that could be withdrawn "美元US$ "(上述证明(I)所列的工程完工百分比) (Percentage of work completed in Part I above)" "减去:至(最近一次申请支付额)提款申请为止的已提款金额 Less: Amount already withdrawn up to withdrawal application (latest application paid) "美元US$ "现要求的提款金额 Amount now requested for withdrawal "美元US$ "(本次申请) (This Application)" 提款签字人 (单位公章) 附件13: 亚洲开发银行项目实际完工进度表 PHYSICAL PROGRESS BY PROJECT ACTIVITIES 截止_____年___月的季度报表 For the Quarter Ending ________, 20 ___ (以百万美元为单位 In Million $) 贷款号Loan No.: 项目名称Project Name: 明细Particulars 成本概算1(以百万为单位) Cost Estimate(In Million $) 实施进度表 Implementation Schedule 时间跨度(第5栏比第6栏) Time Elapsed (Col.5/6) 完成百分比%Percentage(%) Accomplishments 备注Remarks 国外 Foreign 本国 Local 小计 Total 评估时预计开工日期Appl. Sched for Start-up 开工日期 Date Started 延期月份(第5栏减第4栏)Delay in Months (Col.5-4) 预计完工日期 Appraisal Sched for Completion 评估时预计完工日期Target Date of Completion 延期月份(第8栏减第7栏)Delay in Months (Col.8-7) 计划Progress 实际Actual 1 2 3 4 5 6 7 8 9 10 11 12 13 1、可以是据评估报告作的原始估算费用,也可以是经亚行批准的修正估算费用。 提款签字人: (单位公章) 附件14: 国际农发基金贷款项目费用报表(SOE) 类别描述 Description of Category: 报告期限:_____至_______Reporting PeriodFrom____To : IFAD贷款号IFAD Loan No.: 联合国项目服务号UNOPS Project No.: 填报单位Applicant: 申请号Application No.: 填报日期Date: 类别号Category No.: 1 2 3 4 5 6 7 8 9 10 序号Item No. 内容 Description 报告期前累计费用 Cumulative Expenditures up to the Beginning of the Reporting Period 报告期间的费用Expenditures during the Reporting Period 报账比例 Reimbursable under IFAD Loan % of Total in Column 3 申请报帐金额Reimbursable Amount 付款日期 Date of Payment Made 汇率Exchange Rate 申请回补金额 US Dollars Equivalent of Col. 5 Claimed for Replenishment 备注 Remarks 人民币 Renmimbi 美元 US$ 合计Total 上述支出的所有凭证保存在 提款签字人: (单位公章) 附件15: 国际农发基金贷款项目信贷实施表* IFAD PROJECT CREDIT OPERATIONS 国别 Country: IFAD贷款号 IFAD Loan No.: 联合国项目服务办公室项目号 UNOPS Project No.: 项目名称 Project Title: 筹资活动 Activities Financed 贷款支付Loans Disbursed 到期数额Amounts Due 贷款偿还Loans Repaid 纯支付数额 Net Disbursement Amount 贷款笔次 No. of Loans 贷款数额Amounts of Loans 贷款笔次 No. of Loans 贷款数额Amounts of Loans 贷款笔次 No. of Loans 贷款数额Amounts of Loans 本金Principal 利息Interest 本金Principal 利息Interest 1 2 3 4 5 6 7 8 2-7 合计Total 项目会计: 项目主任: 提款签字人: 公章: *注:此表为作为SOE表附表一起提交。 |