Appendix __

REPORT OF COLLECTIONS AND DEPOSITS

Report No. : ______________________

LGU: ________________________________ Sheet No. : _______________________
Fund: ________________________________ Date : ___________________________

Amount
Official Receipt/ Report of
Responsibility Breakdown of Collections
Collections by Sub-Collector Payor Particulars MFO/PAP
Center Code Total per OR Taxes Fees
Date Number 40101010 40201010
75

Total

Summary:
Undeposited Collections per last Report P xxx.xx
Collections per OR Nos. __________to____________ xxx.xx
Deposits
Date: ________________ P xxx.xx
Date: ________________ xxx.xx xxx.xx
Undeposited Collections, this Report P xxx.xx

CERTIFICATION

I hereby certify on my official oath that the above is a true statement of all collections and
deposits had by me during the period stated above for which Official Receipt Nos. ______________ to
_____________ inclusive, were actually issued by me in the amounts shown thereon. I also certify that I
have not received money from whatever source without having issued the necessary Official Receipt in
acknowledgement thereof. Collections received by sub-collectors are recorded above in lump-sum opposite
their respective collection report numbers. I certify further that the balance shown above agrees with the
balance appearing in my Cash Receipts Record.

Name and Signature of the Collecting Officer

_________________________
Official Designation Date
 Appendix 34

Page 1 of 2

REPORT OF COLLECTIONS AND DEPOSITS

LGU

Fund: Report No.:

Name of Accountable Officer: Sheet No:
Date:
A. COLLECTIONS
1. For Collectors

Official Receipt/Serial No.

Type (Form No.) Amount
From To

2. For Liquidating Officers/Treasurers

Name of Accountable Officer Report No. Amount

B. REMITTANCES/DEPOSITS
Accountable Officer/Bank Reference Amount
 Appendix 34

Page 2 of 2

C. ACCOUNTABILITY FOR ACCOUNTABLE FORMS

Beginning Balance Receipt Issued Ending Balance

Name of Form & Inclusive Serial Nos. Inclusive Serial Nos. Inclusive Serial Nos. Inclusive Serial Nos.
No. Qty. Qty. Qty. Qty.
From To From To From To From To

D. SUMMARY OF COLLECTIONS AND REMITTANCES / DEPOSITS

List of Checks :
Beginning Balance ___________ 20 ___ P xxx Check No. Payee Amount
Add: Collections
Cash xxx
Check/s xxx xxx
Total xxx
Less: Remittance/Deposit to Cashier/
Treasurer/Depository Bank xxx
Balance P xxx
NOTE: Use additional sheet if necessary.

CERTIFICATION: VERIFICATION AND ACKNOWLEDGMENT:

I hereby certify that the foregoing report of collections I hereby certify that the foregoing report of collections has
and deposits, and accountability for accountable forms is true been verified and acknowledge receipt of ________________
and correct. (P___________).

Name and Signature Date Name and Signature Date

Accountable Officer Cashier/Treasurer

E. ACCOUNTING ENTRIES
Particulars Account Debit Credit

Prepared by: Certified Correct:

Signature Chief, Accounting Department/Unit