Appendix 29

CASH RECEIPTS RECORD

Entity Name : _______________________________ Sheet No. : _________________

Fund Cluster : ______________________________ Year : _____________________

_______________________ _____________________________ ______________

Accountable Officer Official Designation Station
UACS Code
Reference
Nature Undeposited
Date No./OR Payor Collection Deposit
MFO/PAP Object Code of Collection Collection
No./DS

CERTIFICATION

I hereby certify on my official oath that the foregoing is a correct and complete record
of all collections and deposits had by me in my capacity as _____(Designation)___________ of
________(Name of Agency)___________ during the period from _________________ to
_______________, inclusives, as indicated in the corresponding columns.

Name and Signature

Date

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