General Form No.

74(A) Republic of the Philippines Annex E

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:
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 Signature: Date: Auditor/Examiner'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
Presented Allowed Disallowed
Denomination No. of Pcs. Amount

Total, As Presented Total

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

C. INVENTORY OF UNUSED ACCOUNTABLE FORMS

With Money Value Without Money Value
Name of Form Qty. Inclusive Serial No. Denomination Amount Name of Form Qty. Inc. Serial No.

Total
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 _______________, 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/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:
 D. STATEMENT OF ACCOUNTABILITY
Nature of Funds (1) (2) (3) (4) (5) (6) TOTAL
Balance, Last Examination
(Date)
ADD: Debits to Accountability

Total Debits to Accountability

LESS: Credits to Accountability

Total Credits to Accountability

Balance of Accountablity as of _______
Inventory of Cash and/or Allowed Cash Items
Shortage or (Overage)
C E R T I FI CAT I O N
I HEREBY CERTIFY that my accountability for the above funds of _______________________________________________________
at the time of examination on ______________20___ is correctly stated above totalling P_____________.

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

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: Date:

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.