Common use of Certifications and Signature Clause in Contracts

Certifications and Signature. Certifications: Modifications to any certifications are not valid or binding, unless otherwise agreed by ADB. By (Name of Borrower or Recipient): Fill in the name as it appears in the Grant Agreement. Date Signed: Enter the date WA is signed by authorized representative(s), not the date it was prepared. Authorized Representative(s): Pass this application to authorized representative(s), who is (are) designated in the Evidence of Authority to Sign Withdrawal Applications form submitted to ADB. Verify that the list of authorized representative(s) has not been changed. Type of Disbursement (Indicate an 'X' in the appropriate box): (select one box) Liquidation of Advance STATEMENT OF EXPENDITURES (SOE) SHEET FOR APDRF GRANT ADB Grant No. Application No. Sheet No. For the period: to Type of Form (Indicate an 'X' in the appropriate box [select one box]): SOE Sheet Oct 2017 - Item No. Contract/PO Record No. for EA's Description of Goods & Services Name & Address of Supplier Date of Payment (Due) Total Amount of xxxx paid/payable ADB's Disbursement Percentage ADB's Share of Expendituresa For Advance Fund Only Remarks Exchange Rate b Amount for Liquidation b Attachment 2 to Schedule 2 * EA = Executing Agency, PO = Purchase Order TOTAL TOTAL Notes:

Certifications and Signature. Certifications: Modifications to any certifications are not valid or binding, unless otherwise agreed by ADB. By (Name of Borrower or Recipient): Fill in the name as it appears in the Grant Agreement. Date Signed: Enter the date WA is signed by authorized representative(s), not the date it was prepared. Authorized Representative(s): Pass this application to authorized representative(s), who is (are) designated in the Evidence of Authority to Sign Withdrawal Applications form submitted to ADB. Verify that the list of authorized representative(s) has not been changed. Type of Disbursement (Indicate an 'X' in the appropriate box): (select one box) Liquidation of Advance STATEMENT OF EXPENDITURES (SOE) SHEET FOR APDRF GRANT ADB Grant No. Application No. Sheet No. For the period: to Type of Form (Indicate an 'X' in the appropriate box [select one box]): SOE Sheet Oct 2017 - Item No. Contract/PO Record No. for EA's Description of Goods & Services Name & Address of Supplier Date of Payment (Due) Total Amount of xxxx bill paid/payable ADB's Disbursement Percentage ADB's Share of Expendituresa For Advance Fund Only Remarks Exchange Rate b Amount for Liquidation b Attachment 2 to Schedule 2 * EA = Executing Agency, PO = Purchase Order TOTAL TOTAL Notes: