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 P

Add: Deposit in Transit 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 P

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 P -

Balance per subsidiary ledger, date per certification P -

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

Adjusted balance per ledger, date of count P -

Balance per Cash Receipt Record/Cashbook, date of count P -

Add(Less): Reconciling Items -

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

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 571,100.00

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 3,710,200.00
Adjusted cash receipt record per ledger P 4,281,300.00

Balance per statement of accountability, August 15, 2009 P 4,281,300.00

Balance per subsidiary ledger, August 15, 2009 P 571,100.00

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 3,710,200.00
Adjusted balance per ledger, Aug. 15, 2009 P 4,281,300.00

Prepared by:

LUCILA A. MAGPANTAY
State Auditor II

Verified by: Reviewed by:

EUSEBIA P. ELMIDO NATIVIDAD S. GARCIA

State Auditor IV Supervising Auditor
 STATEMENT OF ACCOUNTABILITY OF ACCOUNTABLE FORMS WITH MONEY VALUE
As of date of cash count

Accountable Officer :
Designation:
Agency:

Balance on hand Balance of Accountability On Hand per

Name of Forms Date of last CE Received Since Issued Since Date of this CE Actual Count Difference
Qty Serial Number Amount Qty Serial Number Amount Qty Serial Number Amount Qty Serial Number Amount Qty Serial Number Amount Qty Serial Number Amount

I HEREBY CERTIFY that the above Statement of Accountability for

Prepared by: Accountable Forms Without Money Value is true and correct.

__________________________ ___________ _____________________________ ________

Auditor Date Name of Accountable Officer Date
 STATEMENT OF ACCOUNTABILITY OF ACCOUNTABLE FORMS WITHOUT MONEY VALUE
As of date of cash count

Accountable Officer : _______________________________

Designation: _______________________________
Agency: _______________________________

Balance on hand Balance of Accountability On Hand per

Name of Forms Date of last CE Received Since Issued Since Date of this CE Actual Count Difference
Qty Serial Number Qty Serial Number Qty Serial Number Qty Serial Number Qty Serial Number Qty Serial Number

I HEREBY CERTIFY that the above Statement of Accountability for

Prepared by: Accountable Forms Without Money Value is true and correct.

____________________________ ___________ _____________________________ ________

Auditor Date Name of Accountable Officer Date
 INTERNAL CONTROL QUESTIONNAIRE

ICQ Ref. No
No. Control Technique Yes SCW CC Remarks
AO 1 Is the accountable officer appointed or
designated as such?
AO 2 Is the accountable officer given
instructions regarding his/her duties
and responsibilities?
AO 3 Is the employee handling cash
adequately bonded? If so, how much?
_____________
AO 4 Does he have a signature and
handwriting specimen card?
AO 5 Has he submitted his photographs to
COA?
AO 6 Does accountable officer keep a file of
COA and other circulars and other
existing rules pertaining to his/her
work?
ao 7 Is the office properly enclosed and the
Cashier amply protected against
intrusion by unauthorized persons?
AO 8 Is the accountable officer or other
employee handling cash provided with
safe?
AO 9 Is the combination of the safe changed
whenever there is a change of
custodian?
AO 10 Are duplicate combinations of the
accountable officers’ safe on file with
an authorized officer?
AO 11 Does the AO refrain from acting as
cashier or treasurer of savings and loan
association, etc. at the same time?

AO 12 Is access to and responsibility for the

fund vested in one person?
AO 13 Does he keep a cashbook?
 Is the cashbook balance reconciled
with his cash on hand at the close of
each day?
AO 14 Are transactions recorded daily?
AO 15 Does the custodian of the fund have no
access to: a.    Cash receipts?
b.   General accounting records?
AO 18 If custodian of other funds, are they
segregated and accounted for
separately?
AO 16 Are the employees of the cashier’s
office denied access to, or
responsibility over, accounting records,
especially those related to cash?

AO 17 Does he avoid access to or

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

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

COLL 33 Are cash receipts deposited as

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

COLL 41 Is the person making deposit escorted

by armed guards and provided with
transportation facilities?
COLL 42 Are all checks endorsed for deposit and
deposited in appropriate banks?
COLL 43 Are items of deposit subsequently
dishonored by the Bank/Treasury
promptly adjusted in the collecting
officers’ records?
COLL 44 Are totals of bank-authenticated
deposit slips compared with the debit
to respective bank accounts in the book
of original entry?
COLL 45 Are all cash funds and cash receipts in
the debit to respective bank accounts in
the book of original entry?

COLL 46 Are acknowledged deposits or deposits

in transit invariably cleared the
following months?
COLL 47 Are collection and deposits recorded
daily in the cash book?
COLL 48 Is the cash book balance compared
daily with the cash on hand?
COLL 49 Are collection reports submitted
regularly to accounting division?
COLL 50 Is reconciliation made monthly of the
collecting officer’s book balance and
the accounting subsidiary ledger
balance?
COLL 51 Is the mail opened by an employee who
is independent of either cashier’s office
and the accounting office?
COLL 52 Are mail remittance recorded or listed
by the person opening the mails?
COLL 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?
COLL 54 Are official receipts booklets used? If
so,
COLL Are the official receipts pre-numbered?
COLL Are the booklets issued in numerical
sequence?
COLL Is the form of payment indicated in the
receipts?
COLL Is the numerical sequence of issued
officials receipts and booklets checked
by the accounting department?

COLL Is a register of forms maintained? If so,

is it kept up-to-date?
COLL 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?
CA 28 Are funds reimbursement checks made
payable to the order of the custodian?

CA 29 Is the fund reasonable in amount?

DISB. 55 Is there a “ceiling” for individual
payments from the fund/funds? If so,
indicate limits:
_______________________________
_____
DISB. 56 Are there no cash on hand except for
Petty Cash Funds and remittances
received after daily deposit is made?
DISB. 57 Is the Imprest Fund system used?
DISB. 58 Are charges made in the stated amount
of the fund authorized?
DISB. 59 Are all significant petty cash funds
counted periodically on a surprise
basis? Indicate who counts.
_______________________________
________
DISB. 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 items promptly

cleared?