Claim Outstanding Payments
Company name
Registered Address of the Company
City
Official Email ID
Official Mobile Number
Name of Authorised Representative Submitting request
State
RO-moRTH
NH Div/BRO/PIU
Project Name
Km Chainage
NH No
Length (Kms.)
Project Type
Date of Work Award
Upload legible copy of LoA (pdf only)
Agreement Date
Upload Copy of Agreement (pdf only)
Completion Date
Type of Work Done in the project
Contract Amount(in INR)
Cumulative Amount Claimed till date(in INR)
Cumulative Amount Received till date(in INR)
Outstanding Payment Claimed Now(in INR)
Documents / All Correspondence in support of Outstanding Claims
Other Relevant Document (Please upload PDF only)
Remarks
Application No.