SCHEDULE OF DORMANT RECEIVABLE ACCOUNTS Annex 1 .

Government Entity Name:___________________________________________

As of the Quarter Ending _______

Account Title: _____________________________________________

AGING OF DORMANT RECEIVABLE ACCOUNTS
Remarks (Reason
Transaction
Name of Debtor more than 20 for being
Date Amount 10 years 11 to 15 years 16 to 20 years
years dormant)

TOTAL

Certified Correct by: Approved by:

__________________________ _____________________________
Entity Chief Accountant Head of Entity or
Authorized Representative
Date: _________________ Date: _________________
 SCHEDULE OF DORMANT CASH ADVANCES Annex 2 ,
Government Entity Name:____________________________________
As of the Quarter Ending _______

Account Title: _____________________________________________

AGING OF DORMANT CASH ADVANCES
Date Remarks (Reason for
Name of Accountable Officer more than 20
Granted Amount 10 years 11 to 15 years 16 to 20 years being dormant)
years

TOTAL

Certified Correct by: Approved by:

__________________________ _____________________________
Entity Chief Accountant Head of Entity or
Authorized Representative
Date: _________________ Date: _________________
 Annex 3 ,
SCHEDULE OF DORMANT INTER-AGENCY FUND TRANSFER
Government Entity Name:__________________________________________
As of the Quarter Ending _______

Account Title: _____________________________________________

AGING OF DORMANT INTER-AGENCY FUND TRANSFER
Date Remarks (Reason for
Name of Government Entity more than 20
Granted Amount 10 years 11 to 15 years 16 to 20 years being dormant)
years

TOTAL

Certified Correct by: Approved by:

__________________________ _____________________________
Entity Chief Accountant Head of Entity or
Authorized Representative
Date: _________________ Date: _________________
 Annex 4

REGISTRY OF ACCOUNTS WRITTEN OFF

Entity Name : __________________________________

Account Title :___________________________________ Fund Cluster : _____________
UACS Object Code :______________________________ Sheet No. : ________________

Reference No. of Years

Particulars Reason for Write-off Authority Uncollected/ Amount
Date No.
Unliquidated
 Annex 5 ,

QUARTERLY REPORT ON REQUESTS FOR WRITE-OFF

Government Entity Name:_________________________________________
For the Quarter Ending ______________________________

Account Title: ____________________________________

Accountable Amount Actions Taken Status of Denied Requests

Reference Officer/Debtor New/ Amount Pending (for
Date Pending Appealed Date Refiled Date Appealed Remarks
Number /Government Refiled action)
Entity Granted Denied
(1) (2) (3) (4) (5) (6) (7) (8)

A. Carry Over of Pending/Denied Requests

B. Request for the Quarter

Submitted by:

_______________________

Date:___________________