CASH COUNT FORM

Instructions

This form is used to record our cash count when the client has a significant amount of cash in hand.

Client Audit Date Date

Name of Fund Counted By Time

Quanity Amount Total

Currency
1000's $0.00
500's $0.00
100's $0.00
50's $0.00
10's
5's
2's $0.00
1's $0.00 $0.00

Coins

Checks for Deposits list attached

Cash Items " "
Advances " "
Undistributed Disbursements " "
Bad Checks " "
Other " "
TOTAL $0.00

Above listed cash items in the amount of ____________________________________ Rupees

(Rs. ______________________ ) were returned to me after count by a representative of FRSH.
All cash and cash items for which I am accountable to ________________________________
have been presented for inspection and count.

Date Signature of Custodian