Annex E

General Form No. 74(A)

Republic of the Philippines
COMMISSION ON AUDIT

REPORT OF CASH EXAMINATION

Name of Accountable Officer: Position/Designation:

Agency: Station:

Maximum Cash Amount of Effective

Risk No.:
Accountability: Bond: Date:

Auditor/Examiner: Official Designation:

A. CASH PRODUCTION NOTICE

TO: Accountable Officer: Position/Designation: Date:

DEMAND, is hereby made that you produce all your cash, checks,
money orders, cash items, paid vouchers, and/or unused accountable
forms, etc., for which you are officially accountable as ______________
of the _____________ and any fund, checks, and/or cash items in your
possession held by you for deposit and safekeeping.

NOTED AND
Accountable Officer's Auditor/Examiner's
COMPLIED Date:
Signature: Signature:
WITH

B. CASH COUNT

INVENTORY OF CASH ON INVENTORY OF CASH ITEMS (Include checks,

HAND money orders, etc.)

Paper and Coins: Particulars Amount

No. of
Denomination Amount Presented Allowed Disallowed
Pes.
Total, As Presented Total

TOTAL INVENTORY OF CASH AND/OR ALLOWED

CASH ITEMS (TOD)
C. INVENTORY OF UNUSED ACCOUNTABLE FORMS

With Mo n ey VaI u e Without Money Value

Inc.
Name of Incl usive Name of
Qty. Denomination Amount Qty. Serial
Form Serial No. Form
No.

Total

CERTIFICATION

I HERBY CERTIFY on my orncmt oath: 1 that upon demand by the

Auditor/Exam iner 1 produced all m y casn, checks, m oney 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 m y possession and produced to the
Auditor/Examiner at the time of cash count today __________, 20__ is
correctly stated above and is broken down as follows:

Cash and/or cash items ... ....... . ... ... ...... ... ... ... ... .. __________
Unused accountable forms with money value ..... ...... __________
Unused accountable forms without money value . ..... __________

of which P _________ was disallowed by the Auditor/Exam iner 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.

Accountable Officer's
Position/Designa tion: Agency/Station:
Signature:

SIGNED IN THE PRESENCE OF:

Witness' name and signature: Witness' name and signature: