Approved form under: Building and Construction Industry Security of Payment Act 1999

Building and Construction Industry Security of Payment Regulation 2008 (Clause 16)

Annual retention account statement for retention money trust account This statement is to be provided along with an account review report for a retention money trust account under clause 16 of the Building and Construction Industry Security of Payment Regulation 2008. Expressions used in this statement have the same meanings as in the Building and Construction Industry Act.
Head contractor: [business name of head contracter]
ABN:
Retention money retained by the head contractor from the subcontractor(s) listed in the attachment on page 2 of this statement has been paid into the trust account to which the accompanying account review report relates.
Date of account review report:
Trust account name:
Name of approved ADI at which trust account established:	Date account opened:
Total retention money paid out of account during audit period:	$
Total retention money held in account at end of audit period:	$
Declaration
I, [full name]
being the head contractor, a director of the head contractor or a person authorised by the head contractor on whose behalf this declaration is made, hereby declare that I am in a position to know the truth of the information contained in this statement and that to the best of my knowledge and belief the information contained in this statement about retention money held in the trust account to which the accompanying account review report relates is complete and correct.
NOTE: it is an offence under the Building and Construction Security of Payment Act 1999 for a head contractor who operates a retention money trust account, within three months after the end of the financial year to not provide the Secretary with an account review report and a retention account statement for the account in respect of the financial year. The maximum penalty is $22,000.
It is also an offence under the Act, for a head contractor to knowingly make a statement that is false or misleading in a material particular.
Signature:	Full Name:
Position/ Title:
Date (dd/mm/yyyy)
How to lodge this document Email: SecurityofPayment@customerservice.nsw.gov.au or post to: NSW Fair Trading, Security of Payment Branch, PO Box 972, Parramatta NSW 2124.

Attachment
Schedule of retention money retained from subcontractor(s)
Subcontractor	ABN	Full retention amount retained from subcontractor	Retention amount paid to subcontractor during audit period	Retention amount held at end of audit period