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A.

ACCOUNTABILITY FOR ACCOUNTABLE FORMS


Beginning Balance
Name of form
Inclusive Serial Numbers
and Number
QTY
FROM
TO
QTY
AF3 51
450
5876301
5876750

RECEIPT
FROM

ISSUED
TO

QTY

FROM
5876301
5876345
5876368
5876387
5876402
5876404

ENDING BALANCE
TO
5876342
5876366
5876385
5876398

QTY

FROM

TO

5876434

B. SUMMARY OF COLLECTIONS AND REMITTANCES/DEPOSITS


Beginning Balance
Add: Collections
Total
Less: Remittances/Deposits
Balance

13,960.00

CERTIFICATION
VERIFICATION AND ACKNOWLEDGEMENT
I HEREBY CERTIFY that the foregoing report of Collections and Deposits and Accountability
I HEREBY CERTIFY that the foregoing report of Collections has been Verified
for accountable Forms is true and Correct
and Acknowleged receipt: ____________________________

JIMMY A. DERADA
Cashier Designate

ZENAIDA M. CALUBAQUIB
Collecting Officer