Republic of the Philippines

COMMISSION ON AUDIT

REPORT OF CASH EXAMINATION

Name of Accountable Officer: Position:
Station: CORON - PALAWAN

Maximum Cash Accountability: ₱ 3,000,000.00 Amount of Bond: ₱ 1,500,000.00 Risk No.: 28-15-1694N Effective Date:

Auditor/Examiner: Official Designation:

A. CASH PRODUCTION NOTICE

TO: Accountable Officer: Position: Date:
DEMAND, is hereby made that you produce all your cash, checks, money orders, cash items paid vouchers, unused accountable forms, etc. for which you
are officially accountable as TRUCK DRIVER/SPECIAL COLLECTING OFFICER/SPECIAL DISBURSING OFFICER at the NATIONAL FOOD
AUTHORITY (NFA) PALAWAN PROVINCIAL OFFICE, CORON, PALAWAN and any fund, checks, and/or cash items in your possession held by you for
deposits and safekeeping.
Accountable Officer's Signature Date Auditor/Examiner's Signature:

NOTED AND
COMPLIED WITH

Truck Driver/SCO/SDO Audit Team Member OIC-Audit Team Leader

B. CASH COUNT
INVENTORY OF CASH ON HAND INVENTORY ON CASH ITEMS (Include checks, money orders, etc.)
Paper and coins: Particulars Amount
Denomination No. of pcs. Amount Presented Allowed Disallowed
₱ 1,000.00 5 ₱ 5,000.00 ₱ - ₱ - ₱ -
500.00 -
200.00 -
100.00 4 400.00
50.00 -
20.00 -
10.00 -
5.00 -
1.00 -
0.25 -

Total as presented ₱ 5,400.00 Total ₱ - ₱ - ₱ -

TOTAL INVENTORY OF CASH AND /OR CASH ITEMS ( TO D) ₱ 5,400.00 -
C. INVENTORY OF UNUSED ACCOUNTABLE FORMS
With Money Value Without Money Value
Name of Form Qty. Serial No. Denomination Amount Name of Form Qty. Inc. Serial No.
None - - - Official Receipt 4 0325597 - 0325600
150 0325601 - 0325750

Total - - - 154 pcs.

C E R T I F I C A T I O N

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, May 23, 2016 is correctly stated above and is broken down as follows:

Cash and / or cash items …………………………………. P 5,400.00

Unused accountable forms with money value …………. -
Unused accountable forms without money value …….. 154

of which zero (₱ 0.00) was disallowed by the Auditor/Examiner and (3) that said cash, checks, money orders, cash items, unused accountable forms etc., were
returned to me intact after the cash count.

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

JESSIE L. FETALINO TRUCK DRIVER/SCO/SDO NFA - CORON, PALAWAN

SIGNED IN THE PRESENCE OF:

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

SGOO Head, Security Guard

 D. STATEMENT OF ACCOUNTABILITY

Return of Unused
Rice Cereal Account IRC - 15% Miscellaneous Cereal Procurement Petty Cash
TOTAL
Nature of Funds (RCA) (MSC) Fund by another SDO Fund
(CPF)

Balance, Last Examination, August 27, 2015 P - P - P - P - P P

ADD: Debits to Accountability
- 0.00
0.00

Total Debits to Accountability P - P - P - P - P - P 0.00

LESS: Credits to Accountability

P P P P P -
-
P -

Total Credits to Accountability P - P P P P ₱ 0.00

Balance of Accountability as of May 23, 2016 - 0.00
Inventory of Cash and /or allowed Cash Items - - 5,400.00
Overages ₱ (5,400.00)
CERTIFICATION

I HEREBY CERTIFY that my accountability for the above funds of NFA-PALAWAN PROVINCIAL OFFICE - CORON, PALAWAN at the time of
examination on May 23, 2016 is correctly stated above totaling FIVE THOUSAND FOUR HUNDRED PESOS (P 5,400).

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:
There was no shortage found on the accountabilities of the Accountable Officer. All cash and depository transactions have been correctly and completely
recorded in the cashbook.

Signature of the Auditor/Examiner:

Date

Audit Team Member OIC-Audit Team Leader

INSTRUCTION
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 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 All reports of examination with their supporting papers and letters will be forwarded to their respective Regional Directors in duplicate. In the event of
shortage/irregularity, the procedure outlined under COA Memorandum 83-818 dated November 1983 should should be strictly followed.
6 Checks, treasury warrants, money orders, and other cash items shall be listed on the source for inventory of Cash Items.