This is a document that provides for the release of a lien in respect to the receipt of
progress payments. The lien holder certifies that they have received progress
payments from the debtor. In return for receiving payment, the lien holder agrees to
release the lien registered on certain property belonging to the debtor. This document
can be used by individuals that have a lien on certain property and want to release that
lien based on the receipt of progress payments.
UNCONDITIONAL WAIVER & RELEASE OF LIEN UPON
THE UNDERSIGNED HEREBY CONFIRMS THE RECEIPT OF ____________
($_______) Dollars from ____________________________ [NAME OF PERSON MAKING
THE PAYMENT] (the “Progress Payment”).
1. The Progress Payment received by ___________________ [NAME OF PERSON
RECEIVING PAYMENT] is in respect of ____________________________________
[DESCRIBE TYPE OF DEBT] for which the undersigned has a lien registered in
___________________ [LOCATION WHERE DEBT WAS REGISTERED] as
registration number _____________ [PROVIDE NUMBER].
2. The undersigned hereby covenants and agrees that it does hereby release the said lien
registered in _______________ [PROVIDE LOCATION, AS IN PARAGRAPH
ONE, ABOVE] as registration number ____________ [PROVIDE NUMBER] against
_________________ [NAME OF PERSON WHO HAD THE LIEN AGAINST
HIM/HER] upon its receipt of the Progress Payment as herein mentioned.
3. The release provided by the undersigned is only subject to the Progress Payment for
____________________ and does not and will not cover any retentions retained before
or after the release date save and except for any ______________ which was provided to
________________ before the release for which the payment has not been received by
4. The release provided by the undersigned, shall not in any way, affect any of the terms,
conditions or rights contained in the original agreement made between the undersigned
DATED this ____ day of ___________________, 201_____.
or if party is a Company
I have authority to bind the Company.