Annex 5

QUARTERLY REPORT ON REQUESTS FOR WRITE-OFF

Account Title: Accounts Receivable

Amount Actions Taken Status of Denied Requests

Accountable
Reference New/ Amount Pending (for Date
Date Officer/Debtor/Govern Pending Appealed Date Refiled Remarks
Number Refiled action) Appealed
ment Entity Granted Denied
(1) (2) (3) (4) (5) (6) (7) (8)

A. Carry Over of Pending/Denied Requests

B. Request for the Quarter

None to Report