(Illustrative Example Only)

ANNEX “A”

STATEMENT OF CASH ADVANCES AND LIQUIDATIONS

As of December 31, 200__

Name of Accountable Officer : ___________________________________

Position/Designation: Administrative Officer V/Special Disbursing Officer

CASH ADVANCES:
CA Check
Date Voucher No. No. Purpose* Amount
200__ NONE
Beg. Balance
Jan. 15 0210 131 P 300,000.00
Feb. 15 0261 161 400,000.00
Mar. 20 0311 201 500,000.00
Apr. 2 0361 241 400,000.00
July 14 0391 291 500,000.00
Oct. 10 0481 371 300,000.00
Oct. 20 0501 401 500,000.00
Total Cash Advances P 2,900,000.00

LIQUIDATIONS:
Liquidation
Date Voucher No. Purpose/Remarks** Amount
200__
Feb. 20 0291 P 300,000.00
Mar. 2 0281 100,000.00
July 2 0321 500,000.00
Oct. 20 0381 700,000.00
Total Liquidations P 1,600,000.00

UNLIQUIDATED CASH ADVANCES as of December 31, 200__ P 1,300,000.00

Prepared by:
INSTRUCTIONS:
*Specify the purpose stated on the voucher. If
none is specified, indicate “No purpose
specified.”
**If specific CAs are liquidated, indicate “In _______________________________
Full/partial liquidation of CA voucher(s) Audit Team Leader
No(s) __.” If no CA is specified, indicate
“None specified.”