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Appendix 29
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CASH RECEIPTS RECORD
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Entity Name : _______________________________Sheet No. : _________________
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Fund Cluster : ______________________________Year : _____________________
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__________________________________________________________________
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Accountable OfficerOfficial DesignationStation
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DateReference No./OR No./DSPayorUACS Code Nature
of Collection		CollectionDepositUndeposited Collection
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MFO/PAPObject Code
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C E R T I F I C A T I O N
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 I hereby certify on my official oath that the foregoing is a correct and complete record
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 of all collections and deposits had by me in my capacity as _____(Designation)___________ of
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 ________(Name of Agency)___________ during the period from _________________ to
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 _______________, inclusives, as indicated in the corresponding columns.
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Name and Signature
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Date
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