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    Sworn Statement of Assets, Liabilities and Net Worth

    Uploaded by

    Aldrin Paguirigan
    This document is a sworn statement of assets, liabilities, and net worth that must be filed by public officials and employees under Philippine law. It requires the declarant to disclose their personal information and position; assets like real estate, vehicles, and other property; liabilities and debts; business interests; and names of relatives employed by the government. The declarant and their spouse must sign to certify that the information provided is true and complete, and authorize the Ombudsman to access supporting documentation from government agencies if needed.

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    Sworn Statement of Assets, Liabilities and Net Worth

    Uploaded by

    Aldrin Paguirigan
    50 views3 pages
    This document is a sworn statement of assets, liabilities, and net worth that must be filed by public officials and employees under Philippine law. It requires the declarant to disclose their personal information and position; assets like real estate, vehicles, and other property; liabilities and debts; business interests; and names of relatives employed by the government. The declarant and their spouse must sign to certify that the information provided is true and complete, and authorize the Ombudsman to access supporting documentation from government agencies if needed.

    Original Description:

    Original Title

    Saln 2012 Form

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    This document is a sworn statement of assets, liabilities, and net worth that must be filed by public officials and employees under Philippine law. It requires the declarant to disclose their personal information and position; assets like real estate, vehicles, and other property; liabilities and debts; business interests; and names of relatives employed by the government. The declarant and their spouse must sign to certify that the information provided is true and complete, and authorize the Ombudsman to access supporting documentation from government agencies if needed.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    50 views3 pages

    Sworn Statement of Assets, Liabilities and Net Worth

    Uploaded by

    Aldrin Paguirigan
    This document is a sworn statement of assets, liabilities, and net worth that must be filed by public officials and employees under Philippine law. It requires the declarant to disclose their personal information and position; assets like real estate, vehicles, and other property; liabilities and debts; business interests; and names of relatives employed by the government. The declarant and their spouse must sign to certify that the information provided is true and complete, and authorize the Ombudsman to access supporting documentation from government agencies if needed.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 3

    SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH

    As of ______________________________________
    (Required by R.A. 6713)
    Note: Husband and wife who are both public officials and employees may file the required statements jointly or separately.

    Joint Filing

    Separate Filing

    Not Applicable

    DECLARANT

    POSITION:

    :
    (Family Name)

    (First Name)

    (M.I.)

    AGENCY/OFFICE:

    ADDRESS:

    OFFICE ADDRESS:

    SPOUSE:

    POSITION:
    (Family Name)

    (First Name)

    (M.I.)

    AGENCY/OFFICE:
    OFFICE ADDRESS:

    UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANTS


    HOUSEHOLD
    NAME

    DATE OF BIRTH

    AGE

    ASSETS, LIABILITIES AND NETWORTH


    (Including those of the spouse and unmarried children below eighteen (18) years of age
    living in declarants household)
    1. ASSETS
    a.

    Real Properties*

    DESCRIPTION

    KIND

    (e.g. lot, house and


    lot, condominium
    and improvements)

    (e.g. residential,
    commercial, industrial,
    agricultural and mixed
    use)

    LOCATION

    ASSESSED

    CURRENT FAIR

    VALUE

    MARKET VALUE

    (As found in the Tax Declaration of


    Real Property)

    ACQUISITION
    YEAR

    ACQUISITION COST

    MODE

    Subtotal:

    b. Personal Properties*
    DESCRIPTION

    YEAR ACQUIRED

    ACQUISITION COST/AMOUNT

    Subtotal :
    TOTAL ASSETS (a+b):
    2. LIABILITIES*
    NATURE

    NAME OF CREDITORS

    TOTAL LIABILITIES:
    NET WORTH : Total Assets less Total Liabilities =

    Page 1 of ___

    OUTSTANDING BALANCE

    * Additional sheet/s may be used, if necessary.

    BUSINESS INTERESTS AND FINANCIAL CONNECTIONS


    (of Declarant /Declarants spouse/ Unmarried Children Below Eighteen (18) years of Age Living in Declarants Household)

    I/We do not have any business interest or financial connection.


    NAME OF
    ENTITY/BUSINESS
    ENTERPRISE

    BUSINESS ADDRESS

    NATURE OF BUSINESS
    INTEREST &/OR FINANCIAL
    CONNECTION

    DATE OF ACQUISITION OF
    INTEREST OR
    CONNECTION

    RELATIVES IN THE GOVERNMENT SERVICE


    (Within the Fourth Degree of Consanguinity or Affinity. Include also Bilas, Balae and Inso)

    I/We do not know of any relative/s in the government service)


    NAME OF RELATIVE

    RELATIONSHIP

    POSITION

    NAME OF AGENCY/OFFICE AND ADDRESS

    I hereby certify that these are true and correct statements of my assets, liabilities, net
    worth, business interests and financial connections, including those of my spouse and unmarried
    children below eighteen (18) years of age living in my household, and that to the best of my
    knowledge, the above-enumerated are names of my relatives in the government within the fourth
    civil degree of consanguinity or affinity.
    I hereby authorize the Ombudsman or his/her duly authorized representative to obtain
    and secure from all appropriate government agencies, including the Bureau of Internal Revenue
    such documents that may show my assets, liabilities, net worth, business interests and financial
    connections, to include those of my spouse and unmarried children below 18 years of age living
    with me in my household covering previous years to include the year I first assumed office in
    government.
    Date:

    ______________________________

    (Signature of Declarant)

    (Signature of Co-Declarant/Spouse)

    Government Issued ID:


    ID No.:
    Date Issued:

    Government Issued ID:


    ID No.:
    Date Issued:

    SUBSCRIBED AND SWORN to before me this


    stated government issued identification card.

    day of

    Page 2 of ___

    , affiant exhibiting to me the above-

    _______________________________________
    (Person Administering Oath)

    Page 3 of ___

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