Appendix A, 1 of 2

CER Page No. 1 and 2

General Form No. 74(A)
Republic of the Philippines
COMMISSION ON AUDIT

REPORT OF CASH EXAMINATION

Name of Accountable Officer: LOIDA C. ROSETE Position/Designation: ELECTION OFFICER/ COLLECTING OFFICER
COMELEC REGIONAL OFFICE NO. III, CITY OF SAN FERNANDO, COMELEC REGION III- OFFICE OF THE ELECTION OFFICER,
Agency: PAMPANGA Station: CABANGAN, ZAMBALES
Amount of
Maximum Cash Accountability: Bond: Risk No.: Effective Date:
AUDITOR/EXAMINER: Official Designation:

A. CASH PRODUCTION NOTICE

ELECTION OFFICER/ COLLECTING
TO: Accountable Officer: LOIDA C. ROSETE Position: OFFICER Date: 20-Jul-20

DEMAND, is hereby made that you produce all your cash, checks, money orders, cash items, paid vouchers, and/or unused accountable forms, etc.
COMELEC REGION III- OFFICE OF THE ELECTION
for which you are officially accountable as ELECTION OFFICER/ COLLECTING OFFICER of the OFFICER, CABANGAN, ZAMBALES
and any fund, checks, and/or cash items in your possession held by you for deposit and safekeeping.

NOTED AND Accountable Officer's Signature: Date: Auditor/Duly Authorized Representative's Signature: Date:
COMPLIED (PLEASE SIGN)
WITH LOIDA C. ROSETE 20-Jul-20

B. CASH COUNT
INVENTORY OF CASH ON HAND INVENTORY OF CASH ITEMS (Include checks, money orders, etc.)
Paper and Coin Amount
Particulars
Presented Allowed Disallowed
Denomination No. of Pcs. Amount
P1,000.00 0 P -
500.00 0 -
200.00 0 -
100.00 0 -
50.00 0 -
20.00 0 -
10.00 0 -
5.00 0 -
1.00 0 -
0.50 0 -
0.25 0 -
0.10 0 -
0.05 0 -
0.01 0 -
Total, As Presented P - Total P - P - P -
TOTAL INVENTORY OF CASH AND/OR ALLOWED CASH ITEMS (TO D) P -

C. INVENTORY OF UNUSED ACCOUNTABLE FORMS

With Money Value Without Money Value
Inclusive Inclusive Serial
Name of Form Qty. Serial No. Denomination Amount Name of Form Qty. No.

Total

C E R T I F I C A T I O N
I HEREBY CERTIFY on my official oath: (1) That upon demand by the Auditor/Examiner I produced all my cash,checks, money orders, cash items, paid vouchers, unused accountable
forms etc.,for which I am officially accountable; (2)That the inventory of such cash, cash items and unused accountable forms in my possession and produced to the Auditor/Examiner at the time of
cash count today JULY 20, 2020 is correctly stated above and is broken down as follows:

Cash and/or cash items............................. ....................................…….. ........................₱ -

Unused accountable forms with money value......................................….. ........................₱ -

Unused accountable forms without money value ............................….................................

of which ________₱0.00________________ was disallowed by the Auditor/Examiner and (3) That said cash, checks, money orders, cash items, paid vouchers, unused accountable forms, etc.,
were returned to me intact after the cash count.

Accountable Officer's Signature: Position/Designation: Agency/Station:

(SIGNATURE OVER PRINTED NAME) ELECTION OFFICER/ COLLECTING COMELEC REGION III- OFFICE OF THE ELECTION
LOIDA C. ROSETE OFFICER OFFICER, CABANGAN, ZAMBALES

SIGNED IN THE PRESENCE OF:

(SIGNATURE OVER PRINTED NAME) (SIGNATURE OVER PRINTED NAME)
Witness' name and signature: PES NAME
Witness' name and signature: MARIE JOYCE PAJE
 Appendix A, 2 of 2
CER Page No. 1 and 2

D. STATEMENT OF ACCOUNTABILITY
(1) (2) (3) (4) (5) (6)
Nature of Funds COLLECTIONS TOTALS
Gen.Fund
BALANCE, Last Examination
P - P -
(Date)
Add: Debits to Accountability-
Collections/Receipts: (See Appendix D for details)

Total Debits to Accountability P - P -

Less: Credits to Accountability

Deposits/Remittances: (See Appendix D for details)

Total Credits to Accountability P - P -

Balance of Accountability as of
P - P -
Inventory of Cash and/or Allowed Cash i P - P -
Shortage or (Overage) P - P -
C E R T I F I C A T I O N

I HEREBY CERTIFY that my accountability for the above funds of __________________________________________________ at the time of
examination on ___________________________________________________is correctly stated above totalling __________________.

Accountable Officer's Signature: Position / Designation: Agency / Station:

SIGNATURE OVER PRINTED NAME ELECTION OFFICER III/ COLLECTING COMELEC REGION III- OFFICE OF THE ELECTION
LOIDA C. ROSETE OFFICER OFFICER, CABANGAN, ZAMBALES

I HEREBY CERTIFY that the preceding is a true and correct report of the examination of the cash and accounts of:

Name of Accountable Officer: Designation: Agency/Station Date:

SIGNATURE OVER PRINTED NAME
LOIDA C. ROSETE ELECTION OFFICER III/ JULY 20, 2020
COMELEC REGION III- OFFICE
COLLECTING OFFICER OF THE ELECTION OFFICER,
CABANGAN, ZAMBALES

Remarks:

Signature of Auditor/Examiner: Date:

INSTRUCTIONS
1. This form will be used for the examination of all cash accountable officers in the corporate, national and local government offices.
2. Before proceeding to conduct an examination, the examiner should thoroughly familiarize himself with the revised manual on cash examination:
3. The six (6) columns on the face hereof are left blank to meet all fund requirements.
4. If space provided for is not enough, use it as summary only and support it with schedules.
5. All reports of examination with their supporting papers and letters will be forwarded to their Respective Regional Directors in duplicate.
In the event of shortage, the procedures for reporting and initiation of action outlined under the Revised CEM should be strictly followed.
6. Checks, money orders, paid vouchers and other cash items shall be listged on the space for Inventory of Cash Items.
General Form No. 74(A)
Republic of the Philippines
COMMISSION ON AUDIT

REPORT OF CASH EXAMINATION

Name of Accountable Officer: Position/Designation:

Agency: Station:

Maximum Cash Accountability: Amount of Risk No.: Effective Date:

Bond:

AUDITOR/EXAMINER: Official Designation:

A. CASH PRODUCTION NOTICE

TO: Accountable Officer: Position: Date:

DEMAND, is hereby made that you produce all your cash, checks, money orders, cash items, paid vouchers, and/or unused accountable forms, etc.

for which you are officially accountable as of the

and any fund, checks, and/or cash items in your possession held by you for deposit and safekeeping.

NOTED AND Accountable Officer's Signature: Date: Auditor/Duly Authorized Representative's Signature: Date:
COMPLIED
WITH

B. CASH COUNT
INVENTORY OF CASH ON HAND INVENTORY OF CASH ITEMS (Include checks, money orders, etc.)
Paper and Coin Amount
Particulars
Presented Allowed Disallowed
Denomination No. of Pcs. Amount
P1,000.00
500.00
200.00
100.00
50.00
20.00
10.00
5.00
1.00
0.50
0.25
0.10
0.05
0.01
Total, As Presented Total
TOTAL INVENTORY OF CASH AND/OR ALLOWED CASH ITEMS (TO D)

C. INVENTORY OF UNUSED ACCOUNTABLE FORMS

With Money Value Without Money Value
Inclusive Inclusive Serial
Name of Form Qty. Serial No. Denomination Amount Name of Form Qty. No.

Total

C E R T I F I C A T I O N
I HEREBY CERTIFY on my official oath: (1) That upon demand by the Auditor/Examiner I produced all my cash,checks, money orders, cash items, paid vouchers, unused accountable
forms etc.,for which I am officially accountable; (2)That the inventory of such cash, cash items and unused accountable forms in my possession and produced to the Auditor/Examiner at the time of
cash count today is correctly stated above and is broken down as follows:

Cash and/or cash items............................. ....................................…….. ........................₱

Unused accountable forms with money value......................................….. ........................₱

Unused accountable forms without money value ............................….................................

of which _______ _______________ was disallowed by the Auditor/Examiner and (3) That said cash, checks, money orders, cash items, paid vouchers, unused accountable forms, etc., were
returned to me intact after the cash count.

Accountable Officer's Signature: Position/Designation: Agency/Station:

SIGNED IN THE PRESENCE OF:

Witness' name and signature: Witness' name and signature:

 D. STATEMENT OF ACCOUNTABILITY
(1) (2) (3) (4) (5) (6)
Nature of Funds COLLECTIONS TOTALS
Gen.Fund
BALANCE, Last Examination

(Date)
Add: Debits to Accountability-
Collections/Receipts:

Total Debits to Accountability

Less: Credits to Accountability

Deposits/Remittances:

Total Credits to Accountability

Balance of Accountability as of

Inventory of Cash and/or Allowed Cash items

Shortage or (Overage)
C E R T I F I C A T I O N

I HEREBY CERTIFY that my accountability for the above funds of __________________________________________________ at the time of
examination on ___________________________________________________is correctly stated above totalling __________________.

Accountable Officer's Signature: Position / Designation: Agency / Station:

I HEREBY CERTIFY that the preceding is a true and correct report of the examination of the cash and accounts of:

Name of Accountable Officer: Designation: Agency/Station Date:

Remarks:

Signature of Auditor/Examiner: Date:

INSTRUCTIONS
1. This form will be used for the examination of all cash accountable officers in the corporate, national and local government offices.
2. Before proceeding to conduct an examination, the examiner should thoroughly familiarize himself with the revised manual on cash examination:
3. The six (6) columns on the face hereof are left blank to meet all fund requirements.
4. If space provided for is not enough, use it as summary only and support it with schedules.
5. All reports of examination with their supporting papers and letters will be forwarded to their Respective Regional Directors in duplicate.
In the event of shortage, the procedures for reporting and initiation of action outlined under the Revised CEM should be strictly followed.
6. Checks, money orders, paid vouchers and other cash items shall be listged on the space for Inventory of Cash Items.