You are on page 1of 2

General Form No. 74 (A) Revised Dec.

20, 1983 REPUBLIC OF THE PHILIPPINES COMMISSION ON AUDIT REPORT OF CASH EXAMINATION
Name of Accountable Officer: Agency: Maximum Accountability: Auditor/Examiner: Amount of Bond: Position: Station: Risk No: Official Designation: A. CASH PRODUCTION NOTICE TO: Accountable Officer: Position: Date: Effective Date:

DEMAND, is hereby made that you produce all your cash, treasury warrants, checks, money orders, cash items, paid vouchers, unused accountable forms, etc., for which you are officially accountable as __________________________ of the________________________________ and any fund, checks, treasury warrants and/or cash items in your possession held by you for deposit and safekeeping. NOTED AND COMPLIED WITH Accountable Officers Signature: Date: Auditor/Duly Authorized Representatives Signature:

INVENTORY OF CASH ON HAND Paper and Coins: Denomination No. of Pcs. Amount

INVENTORY OF CASH ITEMS Particulars Allowed Amount Disallowed

Total, as presented

Total, As Presented

B. TOTAL INVENTORY OF CASH AND/OR ALLOWED CASH ITEMS (TO D) .. C. INVENTORY OF UNUSED ACCOUNTABLE FORMS With Money Value Name of Form Qty Serial No. Denom. Amount Name of Form Without Money Value Qty Serial No.

C E R T

I HEREBY CERTIFY on my official oath: (1) That upon demand by the Auditor/Examiner I produced all my cash, treasury warrants, checks, money orders, cash items, paid vouchers, unused accountable forms, etc., for which I am officially accountable; (2) That the inventory of such cash items and unused accountable forms in my possession and produced to the Auditor/Examiner at the time of cash count today ___________________ is correctly stated above and is broken down as follows: 1) Cash and/or cash items P __________ 2) Unused accountable forms with money value P _________ 3) Unused accountable forms without money value Pcs. _______ of which ( P ) was disallowed by the Auditor/Examiner and (3) That said cash, treasury warrants, checks, money orders, cash items, paid vouchers, unused accountable forms, etc., were returned to me intact after the cash count. Position: Agency/Station:

Accountable Officers Signature:

Signed in the presence of:

D. STATEMENT OF ACCOUNTABILITY
(1) (2) (3) (4) (5) (6)

Nature of Funds BALANCE, Last Examination (Date) ____________________ ADD: Debits to Accountability

TOTALS

Total Debits to Accountability Less: Credits to Accountability

Total Credits to Accountability Balance of Accountability as of Inventory of Cash and/or allowed Cash Items Shortage or (Overage)
C E R T I F C A T I O N

I HEREBY CERTIFY that my accountability for the above funds of ___________________________________________at the time of examination on ____________________________is correctly stated above totaling _________________________ (P_______________________________)

Accountable Officers Signature

Designation:

Agency/Station:

I HEREBY CERTIFY that the preceding is true and correct report of the examination of the Cash and Accounts of: Name of Accountable Officer: Remarks: Signature of Auditor/Examiner: INSTRUCTIONS: 1. 2. 3. 4. 5. 6. This form will be used for the examination of all cash accountable officers in the corporate, national and local government offices. Before proceeding to conduct examination, the examiner should thoroughly familiarize himself with the revised manual on cash examination. The six (6) columns on the face hereof are left blank to meet all fund requirements. If space provided for is not enough, use it as summary only and support it schedules. All reports of examination with their supporting papers and letters will be forwarded to their respective Regional Directors in duplicate. In the event of shortage/irregularity, the procedures outlined under COA Memorandum 83-81B dated November 1983 should be strictly followed. Checks, treasury warrants, money orders, and other cash items shall be listed on the space for Inventory of Cash Items. Date: Designation: Agency/Station: Date:

You might also like