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74 (A) Appendix A
Republic of the Philippines
COMMISSION ON AUDIT
NOTED AND Accountable Officer's Signature: Date: Auditor/Duly Authorized Representative's Signature:
COMPLIED
06/25/2018
WITH
B. C A S H COUNT
INVENTORY OF CASH ON HAND INVENTORY OF CASH ITEMS (Include checks, money orders, etc.)
Paper and Coins: Amount
No. of Particulars
Denomination Amount Presented Allowed Disallowed
Pcs.
Bills
1,000.00 15 ₱ 15,000.00 Schedule I - Schedule of Inventory of 4,655.00 4,655.00
500.00 - - Cash Items
200.00 - -
100.00 2 200.00
50.00 1 50.00
20.00 2 40.00
Coins
10.00 - -
5.00 10 50.00
1.00 5 5.00
0.25 - -
0.10 - -
0.05 - -
0.01 - -
Total as Presented ₱ 15,345.00 Total 4,655.00 4,655.00
TOTAL INVENTORY OF CASH AND/OR ALLOWED CASH ITEMS (TO D) . . . . . . . . 20,000.00
C. INVENTORY OF UNUSED ACCOUNTABLE FORMS
With Money Value Without Money Value
Name of Form Qty. Incl. Serial No. Denomination Amount Name of Form Quantity Incl. Serial No.
Total
CERTIFICATION
I HEREBY CERTIFY on my official oath: (1) That upon demand by the Auditor/Examiner, I produced all my cash, checks, money orders, cash
items,paid vouchers, unused accountable forms, etc.; for which I am officially accountable; (2) That the inventory of such cash, cash items and unused
accountable forms in my possession and produced to the Auditor/Examiner at the time of cash count today, June 25, 2018 is correctly stated above and
is broken down as follows:
of which (₱ 0.00) was disallowed by the Auditor/Examiner and (3) That said cash, checks, money orders, cash items, paid vouchers, unused
accountable forms, etc. were returned to me intact after the cash count.