Appendix _____

CASH JOURNAL
Month ______________________
Agency _________________
Fund _________________ Sheet No. ______________
C O L L E C T I O N S R E M I T T A N C E

Credit Debit

Date RCD No. JEV No. Name of Collecting Debit SUNDRY SUNDRY Credit

Officer 106 Acct. Code P Amount Acct. Code P Amount 106

 Appendix

CHECK DISBURSEMENTS JOURNAL

Month
Agency
Fund Sheet No.

Serial No. of CREDIT DEBIT

Name of
Checks Disbursing S UND R Y SUNDRY
DATE JEV RCI/DV Officer
No. No. From To Acct. Code P Amount Acct. Code P Amount
21

AO 5-14-02
 Appendix ______

CASH DISBURSEMENTS JOURNAL

Month ___________________________
Agency
Fund Sheet No.

CREDIT DEBIT

SUNDRY SUNDRY
DATE JEV No. RD No. Name of Disbursing Officer

Acct. Code P Amount P

Acct. Code Amount
23

AO 5-14-02
 Appendix ______

CHECK DISBURSEMENTS RECORD

Agency
Fund Sheet No.

Accountable Officer Official Designation Station

Check NCA
Date Date Name of Payee UACS Code Nature of Payment Received/ Checks Bank/NCA
No. Deposit Made Issued Balance
Released
Received

CERTIFICATION

I hereby certify that the foregoing is a correct and complete record of all checks
issued by me in my capacity as ____________________ of ___________________________
______________ during the period from _______________ to _______________, inclusives,
as indicated in the corresponding columns.

___________________________
Name and Signature
________________
Date
For Accountable Officers' Use
 Appendix 46

REPORT OF CHECKS ISSUED

Period Covered: ______________

LGU : ___________________________________________________
Fund : __________________________________________________ Report No.: _____________
Bank Name/Account No. : __________________________________ Sheet No.: ______________

Check DV/Payroll Responsibility

CAFOA No. Payee Account Code Nature of Payment Amount
Date Serial No. No. Center Code

Total

CERTIFICATION RECEIVED BY:

I hereby certify on my official oath that this Report of Checks Issued in _________ sheet(s) is
a full, true and correct statement of all checks issued by me during the period stated above for which
Check Nos. ___________ to _____________ inclusive, were actually issued by me in payment for
obligations shown in the attached disbursement vouchers/payroll.

Name and Signature of the Treasurer/Cashier/Disbursing Officer Signature over Printed Name

Official Designation Date Date

 Appendix 38

REPORT OF CHECKS ISSUED

Period Covered: ______________

LGU : ___________________________________________________
Fund : __________________________________________________ Report No.: _____________
Bank Name/Account No. : __________________________________ Sheet No.: ______________

Check DV/Payroll
CAFOA No. Payee Nature of Payment Amount
Date Serial No. No.

Total

CERTIFICATION RECEIVED BY:

I hereby certify on my official oath that this Report of Checks Issued in _________ sheet(s) is
a full, true and correct statement of all checks issued by me during the period stated above for which
Check Nos. ___________ to _____________ inclusive, were actually issued by me in payment for
obligations shown in the attached disbursement vouchers/payroll.

Name and Signature of the Treasurer/Cashier/Disbursing Officer Signature over Printed Name

Official Designation Date Date