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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 2015
(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
DECLARANT

 Separate Filing

Pirote

Avaglez

C.

(Family Name)

(First Name)

(M.I.)

 Not Applicable
Administrative Assistant III

POSITION:

:
ADDRESS:

42-A Burgos St.

AGENCY/OFFICE:

DEPED-CSDT

OFFICE ADDRESS:

TPES Compound, Tacurong City

Tacurong City,SK
SPOUSE:

Sultan Kudarat

Pirote

Kelvin Roy

(Family Name)

(First Name)

J.

N/A

POSITION:

(M.I.)

AGENCY/OFFICE:
OFFICE ADDRESS:

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S HOUSEHOLD
NAME

DATE OF BIRTH

AGE

Princess Jellian C. Pirote
Prince Jullian C. Pirote

July 22, 2008
July 18, 2014

7
1

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

(e.g. lot, house and
lot, condominium
and improvements)

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

LOCATION

VALUE

MARKET VALUE

300 sq
meters

Residential

(As found in the Tax Declaration of
Real Property)

Brgy. Tina,
Tacurong City

ACQUISITION

ACQUISITION
COST

YEAR

MODE

2011

Inst.

P150,000.000

Subtotal:

b. Personal Properties*
DESCRIPTION

YEAR ACQUIRED

ACQUISITION
COST/AMOUNT

Appliances (Television, Aircondition)

2011

P30,000.00

Subtotal : P180,000.00

Page 1 of ___

if necessary. Page 2 of ___ .TOTAL ASSETS (a+b): * Additional sheet/s may be used.

including those of my spouse and unmarried children below eighteen (18) years of age living in my household. LIABILITIES* NATURE NAME OF CREDITORS Residential Lot (300 sq meters) Appliance OUTSTANDING BALANCE Road Show Subd. 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. Date: ______________________________ (Signature of Declarant) Government Issued ID: ID No. 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.: Date Issued: Page 3 of ___ . the aboveenumerated are names of my relatives in the government within the fourth civil degree of consanguinity or affinity. net worth. liabilities.500. if necessary.. business interests and financial connections. Tacurong City Better Homes P80.00 NET WORTH : Total Assets less Total Liabilities = P91.00 TOTAL LIABILITIES: P88.: Date Issued: (Signature of Co-Declarant/Spouse) Government Issued ID: ID No. Tina. 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.000.2. including the Bureau of Internal Revenue such documents that may show my assets.00 * Additional sheet/s may be used. and that to the best of my knowledge.00 P8.500.500. I hereby authorize the Ombudsman or his/her duly authorized representative to obtain and secure from all appropriate government agencies. liabilities. 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. net worth. Include also Bilas. business interests and financial connections.

day of . affiant exhibiting to me the above-stated _______________________________________ (Person Administering Oath) Page 4 of ___ .SUBSCRIBED AND SWORN to before me this government issued identification card.