Annex 30

BANK RECONCILIATION STATEMENT

For the month of ________________
(Date)

SK of Barangay: Bank Name:

City/Municipality: Branch:
Province: Current Account No.:
Particulars RCB Bank Explanatory Comment
Unadjusted Balances xxx xxx
Reconciling Items:
Check Issued not taken up:
In the Books (xx)
By the Bank (xx)
Check Issued Overstated:
In the Books xx
By the Bank xx
Check Issued Understated:
In the Books (xx)
By the Bank (xx)
Deposits not taken up:
In the Books xx
By the Bank xx
Deposits Overstated:
In the Books (xx)
By the Bank (xx)
Deposit Understated:
In the Books xx
By the Bank xx
Bank Debit/Credit Memos, Not taken
up in the books:
Debit Memo (xx)
Credit Memo xx
Other Reconciling Items
Adjusted Balances xx xx

Prepared and Certified Correct by: Approved by:

_________________________ __________________________
Signature over Printed Name Signature over Printed Name
of SK Treasurer of SK Chairperson

Date Date

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 Annex 30

BANK RECONCILIATION STATEMENT

(BRS)
INSTRUCTIONS

A. This statement shall be prepared to reconcile the cash balance per RCB and per bank
statement. It shall be prepared and certified correct by the SK Treasurer, and shall be
accomplished as follows:

1. Date – date covered by the statement

2. SK of Barangay – name of the barangay SK
3. City/Municipality – the city/municipality of the barangay
4. Province – the province of the barangay
5. Bank Name – the bank where the account is maintained
6. Branch – the branch of the bank where the account is maintained
7. Current Account No. – the depository account number for which the BRS is
prepared
8. Particulars – unadjusted balances and the details of reconciling items per RCB and
per bank statement to arrive at the adjusted balances
9. RCB – unadjusted balance of cash per RCB, amounts of reconciling items per RCB
and the adjusted cash balance reconciled with bank
10. Bank – unadjusted balance of cash per bank statement, amounts of reconciling
items per bank and the adjusted cash balance reconciled with RCB
11. Explanatory Comment – brief comments on the reconciling items
12. Prepared and Certified Correct by: signature over printed name of the SK
Treasurer and the date of signing
13. Approved by: signature over printed name of the SK Chairperson and the date of
signing

B. The BRS shall be prepared based on the records per RCB and per bank statement
supported by paid/negotiated/returned checks, debit memos and credit memos.

C. The BRS shall be prepared in four copies to be distributed as follows:

Original copy - COA Auditor

2nd copy - SK Chairperson
3rd copy - SK Treasurer
4th copy - GOB/AGDB, if necessary

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 Annex 31

Republic of the Philippines

_____________________________________
(SK of Barangay, City/Municipality, Province)
Quarterly Statement of Receipts and Payments
For the quarter ended ______________

Receipts
Subsidy from Barangay xxx
Subsidy from Other Local Government Units xxx
Subsidy from National Government Agencies. xxx
Subsidy from Government-Owned and/or Controlled xxx
Corporations
Grants and Donations in Cash
with Specific Purpose xxx
without Specific Purpose xxx
Miscellaneous Income xxx
Other Receipts xxx
Total Receipts for the quarter xxx
Less: Payments
Maintenance and Other Operating Expenses
Travelling Expenses xxx
Training Expenses xxx
Office Supplies Expenses xxx
Semi-Expendable Property Expenses xxx
Fuel, Oil and Lubricants Expenses xxx
Accountable Forms Expenses xxx
Other Supplies and Materials Expenses xxx
Water Expenses xxx
Electricity Expenses xxx
Postage and Courier Services xxx
Telephone Expenses xxx
Internet Subscription Expenses xxx
Prizes xxx
Repairs and Maintenance-Land Improvements xxx
Repairs and Maintenance-Buildings and Other xxx
Structures
Repairs and Maintenance-Machinery xxx
Repairs and Maintenance-Office Equipment xxx
Repairs and Maintenance-Information and xxx
Communications Technology Equipment
Repairs and Maintenance-Sports Equipment xxx
Repairs and Maintenance-Transportation Equipment xxx
Repairs and Maintenance-Furniture, Fixtures and Books xxx
Repairs and Maintenance-Other Property and Equipment xxx
Fidelity Bond Premiums xxx
Advertising Expenses xxx
Rent/Lease Expenses xxx
Membership Dues and Contributions to Organizations xxx
Donation xxx
Honoraria xxx
Bank Charges xxx
Other Maintenance and Operating Expenses xxx
Total Maintenance and Other Operating Expenses xxx
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 Annex 31

Republic of the Philippines

_____________________________________
(SK of Barangay, City/Municipality, Province)
Quarterly Statement of Receipts and Payments
For the quarter ended ______________

Capital Outlay
Land xxx
Land Improvements xxx
Buildings xxx
Other Structures xxx
Machinery xxx
Office Equipment xxx
Information and Communications Technology Equipment xxx
Sports Equipment xxx
Transportation Equipment xxx
Furniture, Fixtures and Books xxx
Other Property and Equipment xxx
Construction in Progress-Land Improvements xxx
Construction in Progress-Buildings xxx
Construction in Progress-Other Structures xxx
Total Capital Outlay xxx

Cash Advances, Net xxx

Total Payments for the quarter xxx

Increase/(Decrease) in Cash for the quarter xxx
Add/Less: Others xxx
Total Increase/(Decrease) in Cash for the quarter xxx
Cash at beginning of quarter
Cash on Hand xxx
Cash in Bank xxx
Cash at end of quarter xxx

Breakdown of Cash at end of quarter

Cash on Hand xxx
Cash in Bank xxx

Prepared and Certified Correct by:

______________________ __________
SK Treasurer Date
Approved by:
______________________ ___________
SK Chairperson Date

229
 Annex 31

QUARTERLY STATEMENT OF RECEIPTS AND PAYMENTS

(QSRP)
INSTRUCTIONS

A. The QSRP shall be prepared by the SK Treasurer quarterly based on the Register of
Cash Receipts and Deposits, and Other Related Financial Transactions (RCRD) and
Register of Cash in Bank and Other Related Financial Transactions (RCB). It shall be
accomplished as follows:

1. SK of Barangay, City/Municipality, Province – name of the barangay SK,

City/Municipality and Province of the Barangay
2. For the quarter ended – date for which the statement is being prepared
3. Receipts – account and the corresponding amount based on the “Totals for the
quarter” of the “Breakdown of Receipts/Direct Deposit” of the RCRD
4. Payments – account and the corresponding amount based on the “Totals for the
quarter” of the “Breakdown of Withdrawals/Payments” of the RCB
5. Increase/(Decrease) in Cash for the quarter – total receipts for the quarter minus
total payments for the quarter
6. Others – amount of other adjustments involving cash such as loss of cash suffered
by SK due to theft/fortuitous events/calamities/civil unrest and events of same
nature
7. Total Increase/(Decrease) in Cash for the quarter – the increase/decrease in cash
for the quarter plus or minus others, if any
8. Cash at beginning of quarter:
- Cash on Hand – balance of cash on hand at the beginning of the quarter based
on RCRD
- Cash in Bank – balance of cash in bank at the beginning of the quarter based on
RCB
9. Cash at end of quarter – total increase/(decrease) in cash for the quarter plus cash
at beginning of quarter (cash on hand and cash in bank)
10. Breakdown of Cash at end of quarter:
- Cash on Hand – balance of cash on hand at the end of the quarter based on
RCRD
- Cash in Bank – balance of cash in bank at the end of the quarter based on RCB

B. The details of the cash advance shall be presented in the Notes to Financial Statements.

C. The SRP shall be prepared and certified correct by the SK Treasurer and duly approved
by the SK Chairperson and the date of signing shall be indicated.

D. This statement shall be prepared in two copies to be distributed as follows:

Original copy - COA Auditor

2nd copy - SK Treasurer
Photocopies of the - SK and Sangguniang Barangay
Original

230
 Annex 32

REPORT OF ACCOUNTABILITY FOR ACCOUNTABLE FORMS

For the quarter ended _________, 20____

SK of Barangay: _____________________ City/Municipality: ________________ RAAF No. _______

SK Treasurer: _______________________ Province: _______________________

Beginning Balance Receipt Issued Ending Balance

Inclusive Inclusive Inclusive Inclusive
Name of Form
Qty. Serial Nos. Qty. Serial Nos. Qty. Serial Nos. Qty. Serial Nos.
From To From To From To From To
A. With Money Value
Cash Tickets

B. Without Money Value

Official Receipts
Checks

CERTIFICATION:

I hereby certify that the foregoing is a true statement of all accountable forms received, issued and
transferred by me during the above-stated period and the correctness of the beginning balances.

__________________________________ __________________
SK Treasurer Date

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 Annex 32

REPORT OF ACCOUNTABILITY FOR ACCOUNTABLE FORMS

(RAAF)

INSTRUCTIONS

A. This report shall be used to report all requisitions and issuances of accountable forms by
the SK Treasurer to be accomplished as follows:

1. For the Quarter Ended ______, 20__ – the quarter covered by the report
2. SK of Barangay – name of the barangay SK
3. SK Treasurer – name of the SK Treasurer
4. City/Municipality – the city/municipality of the barangay
5. Province – the province of the barangay
6. RAAF No. – the RAAF shall be numbered as follows:
0000 - 00 - 000

Serial number (one series for each year)

Month
Year
7. Name of Form – name of accountable forms under the custody of SK Treasurer
8. Beginning Balance – quantity and inclusive serial nos. of accountable forms
available at the beginning of the month
9. Receipt – quantity and inclusive serial nos. of accountable forms received during the
month
10. Issued – quantity and inclusive serial nos. of accountable forms issued during the
month
11. Ending Balance – quantity of accountable forms and inclusive serial nos. still in the
custody of SK Treasurer at the end of the month.
12. Certification – shall be certified by the SK Treasurer and the date of certification shall
be indicated

B. The RAAF shall be prepared in three copies to be distributed as follows:

Original copy - COA Auditor

2nd copy - SK Chairperson
rd
3 copy - SK Treasurer

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 Annex 33
SK of Barangay ____________
City/Municipality___________
Province __________________

SUMMARY OF BUDGET, COMMITMENTS, PAYMENTS AND BALANCES

As at _____________, 20__

Balance, Balance, Unpaid

Particulars Budget Commitments Payments Available Budget Commitments
(a) (b) (c) (a-b) (b-c)
I. Current Year Budget
1. Priority Program
1.a. PPA
MOOE
CO
2. Priority Program
2.a PPA
MOOE
CO
Sub-total

II. Continuing Budget

1. Priority Program
1.a. PPA
CO
2. Priority Program
2.a PPA
CO
Sub-total
Grand Total
Prepared and Certified Correct by: Approved by:

__________________________________________ ________________ __________________________________________ ______________

Signature over Printed Name of Date Signature over Printed Name of Date
Budget Monitoring Officer SK Chairperson
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 Annex 33

SUMMARY OF BUDGET, COMMITMENTS, PAYMENTS AND BALANCES

(SCBCPB)
INSTRUCTIONS

A. The SBCPB shall be prepared by the Budget Monitoring Officer quarterly based on the
Registry of Budget, Commitments, Payments and Balances. It shall be accomplished as
follows:

1. SK of Barangay – name of the barangay SK

2. City/Municipality – the city/municipality of the barangay
3. Province – the province of the barangay
4. As at – date for which the SBCPB is being prepared
5. Particulars – details or information of the amounts presented (Current Year
Budget/Continuing Budget, Priority Program/PPA and MOOE/CO
6. Budget – amount of Annual or Supplemental Budget based on SK Resolution
7. Commitments – refer to the amounts committed to be paid for any lawful
expenditure made by the accountable SK official for and in behalf of the SK
8. Payments – the actual amount paid based on the check issued
9. Balance, Available Budget – total budget less commitments
10. Balance, Unpaid Commitments – total commitments less payments

B. The quarterly totals/balances of the applicable RBCPBs shall be indicated in the

appropriate fields of the SBCPB. Sub-total and grand total shall be computed every
reporting period.

C. The SBCPB shall be prepared and certified correct by the Budget Monitoring Officer
and duly approved by the SK Chairperson and the date of signing shall be indicated.

D. The SBCPB shall be prepared in two copies to be distributed as follows:

Original copy - COA Auditor

2nd copy - Budget Monitoring Officer
Photocopies of the - SK and Sangguniang Barangay
Original

E. The SK shall evaluate the status of their budget based on the SBCPB.

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 Annex 34

SK of Barangay ____________
City/Municipality___________
Province __________________

SUMMARY OF SPECIFIC PURPOSE FUND, COMMITMENTS, PAYMENTS AND BALANCES

As at _____________, 20__

Balance, Available Balance, Unpaid

Particulars Specific Purpose Fund Commitments Payments Specific Purpose Fund Commitments
(a) (b) (c) (a-b) (b-c)
1. Priority Program
1.a. PPA
MOOE
CO
2. Priority Program
2.a PPA
MOOE
CO
3. Priority Program
3.a PPA
MOOE
CO

Grand Total
Prepared and Certified Correct by: Approved by:

__________________________________________ ___________________ ____________________________________ __________________

Signature over Printed Name of Date Signature over Printed Name of Date
Budget Monitoring Officer SK Chairperson

235
 Annex 34

SUMMARY OF SPECIFIC PURPOSE FUND, COMMITMENTS,

PAYMENTS AND BALANCES
(SSPFCPB)
INSTRUCTIONS

A. The SSPFCPB shall be prepared by the Budget Monitoring Officer quarterly based on
the Registry of Specific Purpose Fund, Commitments, Payments and Balances. It shall
be accomplished as follows:

1. SK of Barangay – name of the barangay SK

2. City/Municipality – the city/municipality of the barangay
3. Province – the province of the barangay
4. As at – date for which the SFCPB is being prepared
5. Particulars – details or information of the amounts presented (Priority
Program/PPA and MOOE/CO
6. Specific Purpose Fund – refer to the amounts of funds received with specific
purpose based on SK Resolution
7. Commitments – refer to the amounts committed to be paid for any lawful
expenditure made by the accountable SK official for and in behalf of the SK
8. Payments – the actual amount paid based on the check issued
9. Balance, Specific Purpose Fund – total specific purpose fund less commitments
10. Balance, Unpaid Commitments – total commitments less payments

B. The quarterly totals/balances of the applicable RSPFCPBs shall be indicated in the

appropriate fields of the SSPFCPB. Grand total shall be computed every reporting
period.

C. The SSPFCPB shall be prepared and certified correct by the Budget Monitoring Officer
and duly approved by the SK Chairperson and the date of signing shall be indicated.

D. The SSPFCPB shall be prepared in two copies to be distributed as follows:

Original copy - COA Auditor

2nd copy - Budget Monitoring Officer
Photocopies of the - SK and Sangguniang Barangay
Original

E. The SK shall evaluate the status of their specific purpose fund based on the SSPFCPB.

236
 Annex 35

REPORT ON INVENTORY OF PURCHASED SUPPLIES AND MATERIALS

As at ______________, 20___

SK of Barangay: _______________________
City/Municipality: ______________________
Province: _____________________________
For which _______________________________, _______________ is accountable, having assumed such accountability on _______________.
(Name of Accountable SK Official) (Official Designation) (Date of Assumption)

Balance On Hand Shortage/Overage

Unit of Per Stock Card Per Count Remarks
Article Item Description Stock No. Measurement Unit Cost (Quantity) (Quantity) Quantity Value
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

Prepared and Certified Correct by: Approved by:

_____________________________ _____________________________ _____________________________ __________________________

Signature over Printed Name Signature over Printed Name Signature over Printed Name Signature over Printed Name
Member, Inventory Committee Member, Inventory Committee Head, Inventory Committee SK Chairperson
Date: _________________ Date: _________________ Date: _____________ Date: ______________

237
 Annex 35

REPORT ON INVENTORY OF PURCHASED

SUPPLIES AND MATERIALS
(RIPSM)

INSTRUCTIONS

A. This report shall be prepared semi-annually in the conduct of physical count of

purchased supplies and materials in the custody of SK Treasurer, including unrecorded
items and/or found at station. It shows the balances of supplies and materials per Stock
Card (SC), per count and the shortage/overage, if any. It shall be prepared and certified
correct by the Inventory Committee and approved by the SK Chairperson. It shall be
accomplished as follows:

1. As at – date the count was conducted

2. SK of Barangay – name of the barangay SK
3. City/Municipality – the city/municipality of the barangay
4. Province – the province of the barangay
5. Name of Accountable SK Official – name of the accountable SK official or Supply
and Property Officer
6. Official Designation – official designation of the accountable SK official
7. Date of Assumption – first day of assumption of the duties and responsibilities as
accountable SK official
8. Article – type of item or article (e.g., folder, bond paper, ball pen, stapler, etc.)
9. Item Description – brief description of the item
10. Stock No. – number assigned by the SK Treasurer to the item
11. Unit of Measurement – unit of measurement of the item e.g., box, bottle, piece,
etc.
12. Unit Cost – cost per unit of the item
13. Balance per Stock Card – the balance appearing in the SC
14. On Hand per Count – quantity of items or articles per physical count
15. Shortage/Overage – excess of the quantity and total value of items or articles per
SC over that of the physical count (Shortage) or vice versa (Overage)
16. Remarks – whereabouts, conditions and other relevant information on the
purchased supplies and materials noted during the physical count
17. Prepared and Certified Correct by – signature over printed name of three members
designated as the committee head and members and the date of signing
18. Approved by – signature over printed name of the SK Chairperson and the date of
signing

B. The first six columns shall be filled out by the SK Treasurer while the last four columns
shall be filled out by the Inventory Committee.

C. The RIPSM shall be prepared in three copies to be distributed as follows:

Original copy – COA Auditor

2nd copy – Inventory Committee
3rd copy – SK Treasurer
Photocopies of – SK
the original

238
 Annex 36

REPORT ON INVENTORY OF DONATED SUPPLIES AND MATERIALS

As at ______________, 20___

SK of Barangay: _______________________
City/Municipality: ______________________
Province: _____________________________
For which _______________________________, _______________ is accountable, having assumed such accountability on _______________.
(Name of Accountable SK Official) (Official Designation) (Date of Assumption)

Balance On Hand Shortage/Overage

Unit of Per RDSM Per Count
Article Item Description Stock No. Measurement Unit Cost (Quantity) (Quantity) Quantity Value Remarks
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

Prepared and Certified Correct by: Approved by:

_____________________________ _____________________________ _____________________________ __________________________

Signature over Printed Name Signature over Printed Name Signature over Printed Name Signature over Printed Name
Member, Inventory Committee Member, Inventory Committee Head, Inventory Committee SK Chairperson
Date: _________________ Date: _________________ Date: _____________ Date: ______________

239