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    Saln Fy 2023

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    NJ Nomus
    This document is a sworn statement of assets, liabilities, and net worth that must be filed by public officials and employees in the Philippines. It requires the declarant to disclose their real and personal assets and liabilities, as well as business interests and relatives in government. The declarant authorizes the Ombudsman to obtain tax and financial records to verify the statement.

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    Saln Fy 2023

    Uploaded by

    NJ Nomus
    3 views2 pages
    This document is a sworn statement of assets, liabilities, and net worth that must be filed by public officials and employees in the Philippines. It requires the declarant to disclose their real and personal assets and liabilities, as well as business interests and relatives in government. The declarant authorizes the Ombudsman to obtain tax and financial records to verify the statement.

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    Saln copy

    Original Title

    SALN-FY-2023

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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 in the Philippines. It requires the declarant to disclose their real and personal assets and liabilities, as well as business interests and relatives in government. The declarant authorizes the Ombudsman to obtain tax and financial records to verify the statement.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    3 views2 pages

    Saln Fy 2023

    Uploaded by

    NJ Nomus
    This document is a sworn statement of assets, liabilities, and net worth that must be filed by public officials and employees in the Philippines. It requires the declarant to disclose their real and personal assets and liabilities, as well as business interests and relatives in government. The declarant authorizes the Ombudsman to obtain tax and financial records to verify the statement.

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    © All Rights Reserved
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    You are on page 1of 2

    Revised as of January 2015

    Per CSC Resolution No. 1500088


    Promulgated on January 23, 2015

    SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH


    As of December 31, 2023
    (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:
    AGENCY/OFFICE: DEPED- HACIENDA CONCHITA
    NATIONAL HIGH SCHOOL
    ADDRESS: DAAN BANWA, ESTANCIA,ILOILO OFFICE ADDRESS: HACIENDA CONCHITA, SAN
    DIONISIO, ILOILO

    SPOUSE: POSITION:
    AGENCY/OFFICE:
    OFFICE ADDRESS:

    UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S 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 declarant’s household)
    1. ASSETS
    a. Real Properties*

    DESCRIPTION KIND EXACT ASSESSED CURRENT FAIR ACQUISITION ACQUISITION


    (e.g. lot, house and (e.g. residential, LOCATION VALUE MARKET VALUE COST
    lot, condominium commercial, industrial,
    and improvements) agricultural and mixed (As found in the Tax Declaration of
    Real Property)
    YEAR MODE
    use)

    Subtotal:

    b. Personal Properties*

    DESCRIPTION YEAR ACQUIRED ACQUISITION


    COST/AMOUNT

    HONDA CITY
    GADGETS/ LAPTOPS
    JEWELRIES

    APPLIANCES
    MOTOR CYCLE ( HONDA XR 125 )
    TRICYCLE ( RUSI MOTORCYCLE)

    Subtotal :

    TOTAL ASSETS (a+b):

    Page 1 of 2
    * Additional sheet/s may be used, if necessary.
    2. LIABILITIES*

    NATURE NAME OF CREDITORS OUTSTANDING BALANCE

    TOTAL LIABILITIES:

    NET WORTH : Total Assets less Total Liabilities =

    BUSINESS INTERESTS AND FINANCIAL CONNECTIONS


    (of Declarant /Declarant’s spouse/ Unmarried Children Below Eighteen (18) years of Age Living in Declarant’s Household)
    I/We do not have any business interest or financial connection.
    NAME OF BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF
    ENTITY/BUSINESS INTEREST &/OR FINANCIAL INTEREST OR CONNECTION
    ENTERPRISE 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: DECEMBER 31, 2023

    (Signature of Declarant) (Signature of Co-Declarant/Spouse)

    Government Issued ID: Government Issued ID:


    ID No.: ID No.:
    Date Issued: Date Issued:

    SUBSCRIBED AND SWORN to before me this day of , affiant exhibiting to me the above-stated
    government issued identification card.

    (Person Administering Oath)

    Page 2 of 2

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