CASH COUNT SHEET

Name of the Agency: ___________________________________________________________________

Name of the Accountable Officer: _________________________________________________________
Official Designation: ____________________________ Date of Examination: _____________________
Time Started: _________ Time Finished: ______________ Prepared by: __________________________

DEMAND
Mr./Ms.: _________________________

Demand is hereby made that you produce all your cash, cash items and paid vouchers and payrolls, etc. for which
you are officially accountable as Regular/Special Collecting/Disbursing Officer of the __________________________
and any fund, checks, money orders, treasury warrants and/or cash items in your possession hold for deposit or
safekeeping.

____________________________________ ________________________________
Name and Signature of Accountable Officer Name and Signature of Auditor/Examiner

CURRENCY:
Denomination No. of Pieces Amount
Bills 1,000.00
500.00
200.00
100.00
50.00
20.00
Coins
10.00
5.00
1.00
0.25
0.10
0.05
0.01
Total Currency
Total Cash Items (See Working Paper)
Total Checks, Money Orders/Treasury Warrants (See Working Paper)
Total Currency, Cash Items, Checks, Money Orders, Treasury Warrants
Accountability as of ________________
Overage or (Shortage)

CERTIFICATION

I HEREBY CERTIFY on my official oath: (1) that upon demand by the Auditor/Examiner, I produced all my
cash, treasury warrants, 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, _____________,
at ______A.M/P.M is correctly stated above, totaling
____________________________________________________ (₱_________________), of which
₱______________ was disallowed by the Auditor/Examiner; and (3) That the said cash, treasury warrants,
checks, money orders, cash items, paid vouchers, unused accountable forms, etc., were returned to me intact
after the cash count.

_____________________________________ _______________________________
Name and Signature of Accountable Officer Name and Signature of Auditor/Examiner

WITNESSED BY: ______________________________ _______________________________

Name and Signature Name and Signature