Annex K

Name of Agency
Bank Reconciliation Statement
Name of Fund
Account Number
Name of accountable officer
As of date of cash count
Balance per bank, date per bank statement
Add: Deposit in Transit

P
P

Total
Less: Outstanding Checks

Adjusted balance per bank, date of count

Balance per Check Disbursement Record (CDR)

as of date of cash count
Add (Less): Reconciling Items

Adjusted balance per CDR, date of count

Balance per ledger, as certified by the Accountant

Add (Less): Reconciling Items

Adjusted balance per Ledger, date of count

Prepared by:
Name
Position
Reviewed by:
Audit Team Leader

Name of Agency

Name of Accountable officer

Reconciliation Statement of Accountability
Name of Fund
Date of Cash Count

Balance per statement of accountability, date of cash count

Balance per subsidiary ledger, date per certification

(Please refer to the certification by Accountant)
Add(Less): Reconciling Items

Adjusted balance per ledger, date of count

Balance per Cash Receipt Record/Cashbook, date of count

Add(Less): Reconciling Items

Adjusted balance per Cash Receipt Record/Cashbook, date of count

Prepared by:
Name of Examiner/Auditor

Reviewed by:
Name of ATL
ATL

Anna Liza B. Villanueva - Finance Officer

Reconciliation Statement of Accountability
GENERAL FUND
As of August 15, 2009
Balance per cash receipt record, August 15, 2009
P
Add: Collections fictitiously recorded/reported as deposited
June 16-30, 2009
P
1,106,900.00
July 1 - 31, 2009
2,401,500.00
August 1 - 15, 2009
201,800.00
Adjusted cash receipt record per ledger
P

3,710,200.00
4,281,300.00

Balance per statement of accountability, August 15, 2009

4,281,300.00

Balance per subsidiary ledger, August 15, 2009

P
Add: Collections fictitiously recorded/reported as deposited
P
1,106,900.00
June 16-30, 2009
July 1 - 31, 2009
2,401,500.00
August 1 - 15, 2009
201,800.00
P
Adjusted balance per ledger, Aug. 15, 2009

571,100.00

Prepared by:
LUCILA A. MAGPANTAY
State Auditor II
Verified by:

Reviewed by:
EUSEBIA P. ELMIDO
State Auditor IV

NATIVIDAD S. GARCIA
Supervising Auditor

571,100.00

3,710,200.00
4,281,300.00

STATEMENT OF ACCOUNTABILITY OF ACCOUNTABLE FORMS WITH MONEY VALUE

As of date of cash count
Accountable Officer :

Designation:
Agency:

Name of Forms
Qty

Balance on hand
Date of last CE
Serial Number
Amount

Prepared by:
__________________________ ___________
Auditor
Date

Qty

Received Since
Serial Number Amount

Qty

Issued Since
Serial Number

Amount

Balance of Accountability
Date of this CE
Qty
Serial Number Amount

Qty

On Hand per
Actual Count
Serial Number

Amount

Qty

I HEREBY CERTIFY that the above Statement of Accountability for

Accountable Forms Without Money Value is true and correct.
_____________________________
Name of Accountable Officer

________
Date

Difference
Serial Number

Amount

STATEMENT OF ACCOUNTABILITY OF ACCOUNTABLE FORMS WITHOUT MONEY VALUE

As of date of cash count
Accountable Officer :
Designation:
Agency:

Name of Forms

_______________________________
_______________________________
_______________________________
Balance on hand
Date of last CE
Qty
Serial Number

Issued Since
Qty
Serial Number

Balance of Accountability
Date of this CE
Qty
Serial Number

On Hand per
Actual Count
Qty
Serial Number

Qty

Difference
Serial Number

I HEREBY CERTIFY that the above Statement of Accountability for

Accountable Forms Without Money Value is true and correct.

Prepared by:
____________________________
Auditor

Received Since
Qty
Serial Number

___________
Date

_____________________________
Name of Accountable Officer

________
Date

INTERNAL CONTROL QUESTIONNAIRE

ICQ Ref.
No.
AO

AO

AO

AO

AO

AO

ao

AO

AO

AO

10

AO

11

AO

12 Is access to and responsibility for the

fund vested in one person?
13 Does he keep a cashbook?

AO

No
Control Technique
Is the accountable officer appointed or
designated as such?
Is the accountable officer given
instructions regarding his/her duties
and responsibilities?
Is the employee handling cash
adequately bonded? If so, how much?
_____________
Does he have a signature and
handwriting specimen card?
Has he submitted his photographs to
COA?
Does accountable officer keep a file of
COA and other circulars and other
existing rules pertaining to his/her
work?
Is the office properly enclosed and the
Cashier amply protected against
intrusion by unauthorized persons?
Is the accountable officer or other
employee handling cash provided with
safe?
Is the combination of the safe changed
whenever there is a change of
custodian?
Are duplicate combinations of the
accountable officers safe on file with
an authorized officer?
Does the AO refrain from acting as
cashier or treasurer of savings and loan
association, etc. at the same time?

Yes

SCW

CC

Remarks

Is the cashbook balance reconciled

with his cash on hand at the close of
each day?
Are transactions recorded daily?
Does the custodian of the fund have no
access to: a. Cash receipts?
b. General accounting records?
If custodian of other funds, are they
segregated
and
accounted
for
separately?
Are the employees of the cashiers
office
denied
access
to,
or
responsibility over, accounting records,
especially those related to cash?

AO
AO

14
15

AO

18

AO

16

AO

17 Does he avoid access to or

responsibility over the accounting
records related to cash (such as
subsidiary
ledger
of
Accounts
Receivables)?
61 Are surprise cash examinations
conducted frequently by internal and
external auditors?
62 Does the organization structure provide
a clear-out separation of cashiering
function from accounting function?

AO

AO

Are accounting records up to date?

Are subsidiary records maintained for
each accountable officer?
Are both the totals and details of bank
authenticated duplicate deposit slip
matched by the accounting department
against the corresponding official
receipts?
Are cashbooks balance reconciled with
the subsidiary ledger at least once a
month?

AO

Are unused official receipts and other

accountable forms properly controlled
as to ordering, storing and issuing, and
are adequate records kept of them?

AO

Are monthly reports of accountability

of accountable forms prepared and
submitted?
30 Are the official receipts promptly
issued for collections received?
31 Are official receipts issued in
numerical sequence?
32 Is it the practice of the collecting
officer not to accept post-dated checks
in payment of changes or fees?

COLL
COLL
COLL

COLL
COLL

COLL

COLL
COLL

COLL
COLL
COLL

COLL

33 Are cash receipts deposited as

otherwise required by regulations?
34 Does he refrain from using the
collections for paying obligations of
whatsoever?
36 Are items of deposit subsequently
dishonored by the Treasury promptly
adjusted in the collecting officers
records?
36 Are reports of collections submitted at
the end of the month?
37 Is the collecting officer closely
supervised by a responsible officer of
the agency?
38 Are official receipts issued for every
receipt of payment?
39 Is the cashing of checks from
collections prohibited? If not:
40 Are collections deposited intact and as
frequently as required by regulations?
41 Is the person making deposit escorted
by armed guards and provided with
transportation facilities?

COLL
COLL

COLL

COLL

COLL

COLL
COLL
COLL
COLL

COLL

COLL
COLL

COLL
COLL

42 Are all checks endorsed for deposit and

deposited in appropriate banks?
43 Are items of deposit subsequently
dishonored by the Bank/Treasury
promptly adjusted in the collecting
officers records?
44 Are totals of bank-authenticated
deposit slips compared with the debit
to respective bank accounts in the book
of original entry?
45 Are all cash funds and cash receipts in
the debit to respective bank accounts in
the book of original entry?
46 Are acknowledged deposits or deposits
in transit invariably cleared the
following months?
47 Are collection and deposits recorded
daily in the cash book?
48 Is the cash book balance compared
daily with the cash on hand?
49 Are collection reports submitted
regularly to accounting division?
50 Is reconciliation made monthly of the
collecting officers book balance and
the accounting subsidiary ledger
balance?
51 Is the mail opened by an employee who
is independent of either cashiers office
and the accounting office?
52 Are mail remittance recorded or listed
by the person opening the mails?
53 If so, is the record or list given to
someone other than the collecting
officer for follow up to see that all mail
remittances have been receipted for and
deposited?
54 Are official receipts booklets used? If
so,
Are the official receipts pre-numbered?

COLL
COLL
COLL

COLL
COLL

CA

CA
DISB.

DISB.

DISB.
DISB.
DISB.

DISB.

Are the booklets issued in numerical

sequence?
Is the form of payment indicated in the
receipts?
Is the numerical sequence of issued
officials receipts and booklets checked
by the accounting department?
Is a register of forms maintained? If so,
is it kept up-to-date?
Are unused booklets physically
safeguarded? State how?
Is the prior approval or an authorized
person required before a check is
cashed?
Are such checks deposited promptly?
28 Are funds reimbursement checks made
payable to the order of the custodian?
29 Is the fund reasonable in amount?
55 Is there a ceiling for individual
payments from the fund/funds? If so,
indicate
limits:
_______________________________
_____
56 Are there no cash on hand except for
Petty Cash Funds and remittances
received after daily deposit is made?
57 Is the Imprest Fund system used?
58 Are charges made in the stated amount
of the fund authorized?
59 Are all significant petty cash funds
counted periodically on a surprise
basis?
Indicate
who
counts.
_______________________________
________
60 Are permanent disallowances reflected
in the cashbook?

63 Is the foregoing information considered

adequate as basis for our evaluation of
internal control in that there are no
other additional auditing procedures,
accounting
controls
or
other
circumstances that mitigate weaknesses
indicated above, or in that there are no
other circumstances that impair any
control?
List down any additional controls
and/or weaknesses not covered by the
foregoing questions and/or answers.
Are reconciling
cleared?

items

promptly