Annex 1

SCHIW UL E Ul' DORJ\ Ji\NT HJi:CIGlVABLL~ ACCOUN TS

(; overnment Enfify Nn111e:- -- - - ·
/\s of the Quarter Emling

/\ccuunt Title:

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l.'ctl i li ed Correct hy: Approved by:

Entity Chief /\cco ut llant Head of Entity or

A uthori zed Representa ti ve
IJa le: ----- - - -- - - Dale: ----------------

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SCHEDULE OF DORMANT CASH ADVA NCES Annex 2

Government Entity Na me: _ _ _ _ _ _ _ _ __ _ _ __
As of the Quarter Ending _ _ _

TOTAL

Certifiecl Corred by: Approved by:

Entity Chief Accountant Head of Entity or

Authorized Representative
Date: _ _ _ _ _ __ Date: _ _ _ _ _ _ __

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Annex 3
SCHEDULE OF DORMANT INTER-AGENCY FUND TRANSFER
Government Entity Name: _ _ _ __ _ _ _ __ _ _ _ _ __ __
As of the Quarter Ending _ _ _

Certified CarTee{ by: Approved by:

Entity Chief Accountant Head of Enlity or

Authorized Representati ve
Dale: ~~~~~~--- Dale:

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Annex 4

REGISTRY OF ACCOUNTS WRITTEN OFF

Entity Name: _ _ _ _ _ _ _ _ _ _ _ _ __
Accounl Title :_ _ _ __ _ _ _ _ _ _ _ __
UACS Object Code :_ _ _ _ _ _ _ _ _ _ __
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Annex 5

QUARTERLY REPORT ON REQUESTS FOR WRITE-OFF

Government Entity Name: _ _ _ _ _ __ _ _ _ _ _ _ __ __
For the Quarter Ending _ _ _ __ _ __ _ _ __ _

;\rcou nt T itle:
---------------------------------

'« Submitted by:

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Date:
-----------------

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