General Form No.

74(A) Republic of the Philippines

Revised Dec. 22, 1983 COMMISSION ON AUDIT

REPORT OF CASH EXAMINATION

Name of Accountable Officer: Position/Designation:

Agency: Station:
Maximum Cash Accountability: Amount of Bond: Risk No.: Effective Date:
Auditors/Examiners: 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 a
officially accountable as ___________________________ of the ________________ and any fund, checks, and/or cash items in your possession held by you for deposit an
safekeeping.

NOTED AND Accountable Officer's Signature: Date: Auditor/Duly Authorized Representative's Signature:
COMPLIED
WITH
B. CASH COUNT
INVENTORY OF CASH ON HAND INVENTORY OF CASH ITEMS (Include checks, money orders, etc.)
Paper and Coins: Amount
Particulars
Deno- Presented Allowed
No. of
mination Pcs. Amount
P

Total, As Presented P 0.00 Total

TOTAL INVENTORY OF CASH AND/OR ALLOWED CASH ITEMS (TO D) P

C. INVENTORY OF UNUSED ACCOUNTABLE FORMS

With Money Value Without Money Value

Name of Form Qty Inclusive Serial No. Den. Amount Name of Form Qty. Inc. Serial #

Total 0
C E R T I F I C A T I ON
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 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:
 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/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.
Accountable Officer's Signature: Position/Designation: Agency/Station:

SIGNED IN THE PRESENCE OF:

Witness' name and signature: Witness' name and signature:
Republic of the Philippines
COMMISSION ON AUDIT

RT OF CASH EXAMINATION

Designation:

n:

ASH PRODUCTION NOTICE

Date:

ney orders, cash items, paid vouchers, and/or unused accountable forms, etc., for which you are
______ and any fund, checks, and/or cash items in your possession held by you for deposit and

Auditor/Duly Authorized Representative's Signature:

B. CASH COUNT
INVENTORY OF CASH ITEMS (Include checks, money orders, etc.)
Amount
Disallowed

Y OF UNUSED ACCOUNTABLE FORMS

Without Money Value

Inc. Serial #

E R T I F I C A T I ON
he Auditor/Examiner I produced all my cash, checks, money orders, cash items,
untable; (2) That the inventory of such cash items and unused accountable forms
unt today , is correctly stated above and is broken down as follows:
t said cash, checks, money orders, cash items, paid vouchers, unused accountable

Agency/Station:

NED IN THE PRESENCE OF:

name and signature:
 D. STATEMENT OF ACCOUNTABILITY
Nature of Funds (1) (2) (3) (4) TOTALS
Balance,
ADD: Debits to Accountability

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)
CERTIFICATION
I HEREBY CERTIFY that my accountability for the above funds of , at the time of examination
on , is correctly stated above totalling P .

Accountable Officer's Signature: Position/Designation: Agency/Station:

Liquidating Officer RPHS - Angono Annex
I HEREBY CERTIFY that the preceding is a true and correct report of the examination of the cash and accounts of :

Name of Accountable Officer: Position/Designation: Agency/Station:

Remarks:

Signature of Auditor/Examiner: Date:

1. This form will be used for the examination of all cash accountable officers in the corporate, national and local government offices.
2. Before proceeding to conduct an examination, the examiner should thoroughly familiarize himself with the revised manual on cash examination.
3. The six (6) columns on the face hereof are left blank to meet all fund requirements.
4. If space provided for is not enough, use it as summary only and support it with schedules.
5. Only reports showing a discrepancy in the accountability of the AO should be forwarded to respective Cluster/Regional Directors in duplicate.
In the event of shortage, the procedures for reporting and initiation of action outlined under the Revised CEM should be strictly followed.
6. Checks, treasury warrants, money orders, and other cash items shall be listed on the space for Inventory of Cash Items.