TO: CONTRACTOR:
{1246:Name and address of the company that obtained the bond for the project}
TO: SUBCONTRACTOR (IF ANY):
{1214:Enter the Name and Address of the Subcontractor}
SURETY:
{1199:If known, the name and address of the company that issued the bond for the project (the surety)}
FROM: CLAIMANT
{1193:company:Contact Details}
{1193:address:Contact Details}
{1193:city:Contact Details}, {1193:zone:Contact Details} {1193:pincode:Contact Details}
NOTICE IS HEREBY GIVEN that the undersigned claimant has a claim against the above named surety for labor or materials furnished by the undersigned for the public work described as follows:
The name and location of the project is as follows:
{1244:What is the name of the project?}
{1245:Project Address}
The labor or materials were furnished pursuant to a contract or agreement with:
{1592:Name of the company that hired you to perform work on the project}
The nature of the labor or materials furnished is as follows:
{1218:Describe the materials you furnished and the work you performed on the project}
The amount of the claim is:
${1226:Unpaid amount due to you}
The date the claimant last furnished labor or materials to this public work is:
{1219:Last date you provided Labor and/or Materials}
Claimant seeks payment of said claim according to the law.
{1193:company:Contact Details}
By:____________________________
{1236:Name of duly authorized company officer entitled to sign the bond claim}, {1237:Position with Company}
STATE OF _____________
ss.
COUNTY OF ____________
Subscribed and sworn to before me this ____ day of _____________, 20__.
_________________________
NOTARY PUBLIC