*With Additional Sheet: Yes No Revised as of January 2015

Per CSC Resolution No. 1500088

Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NETWORTH

As of 31 December 2019
(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 Separate Others: ______________
DECLARANT: Ea Muriel Jezryl V RANK/SN/POSITION: Cpl/Light Truck Driver
(Family Name) (First Name) (M.I.) UNIT/AGENCY: 61IB, 3ID, PA
ADDRESS: Prk. Rang-Ay Brgy. Kalanawi II, Prisiden OFFICE ADDRESS: Camp Monteclaro, Brgy Igtuba,
t
Quirino, Sultan Kudarat Miagao, Iloilo

SPOUSE: Ea Lanedie E RANK/SN/POSITION: Plain House Wife

(Family Name) (First Name) (M.I.) UNIT/AGENCY:
ADDRESS: Prk. Rang-Ay Brgy. Kalanawi II, Prisiden OFFICE ADDRESS:
t
Quirino, Sultan Kudarat

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S HOUSEHOLD
NAME DATE OF BIRTH AGE
Hezekiah E Ea 10 March 2016 3 Yrs old & 10 Mos

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 ACQUISITION

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

Lot Agriculture Mindanao 200,00.00 2013 Cash 200,000.00

Lot Residentail Mindanao 260,000.00 2018 Cash 260,000.00

House Residential Mindanao 358,000.00 2018 Cash 358,000.00

*With Additional Sheet: Yes No

Subtotal: 818,000.00
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT

Netbook Two (2) Pcs 2013 16,000.00

Mobile Phone (Samsung) 2013 1,850.00
Motorcycle (RS) 2017 96,000.00
Gadgets Two (2) Cellphones 2017 38,693.00
TV (LG) 2018 16.500.00
18 Karat Saudi Gold (3 Necklaces, 4 Rings, 2 bracelets, 4 Pairs of 2018 59,525.00
Earings) 25.33g
Gadgets Two (2) cellphones 2019 18,300.00

Subtotal : Php 246,868.00

TOTAL ASSETS (a+b): Php 1,064,868.00

LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

Salary Loan AFPSLAI 200,000.00

Policy Loan PAFCPIC 86,000.00
Salary Loan PAFCPIC 236,242.00
Salary Loan PAFCPIC 601,380.00
Policy Loan MBAI 17,958.00

Page 1 of _____
 Salary Loan MBAI 26,583.00
Salary Loan MBAI 50,000.00
*With Additional Sheet: Yes No TOTAL LIABILITIES: Php 1,218,163.37

NET WORTH : Total Assets less Total Liabilities = Php 153,295.37

BUSINESSINTERESTSANDFINANCIALCONNECTIONS
(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 ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF

ENTERPRISE INTEREST &/OR FINANCIAL INTEREST OR CONNECTION
CONNECTION
None None None None

RELATIVESINTHEGOVERNMENTSERVICE
(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
Eula E Panisa Cousin Teacher 2 DepEd / Kalamansig Sultan Kudarat
Ruel Ea Cousin Teacher/ H.S DepEd / Kalanawi II, Pres. Qui. Sul. Kud
Riden S Ea Cousin Soldier 351IB / Julo, Sulo
Jezzer S Ea Cousin Soldier 32IB / Julo, Sulo

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, networth, 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: 05 January 2020

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

Government Issued ID: Military ID Government Issued ID: Military Dependent ID

ID No.: A18-E-195178 ID No.: DA18-E-162448
Date Issued: 22 November 2018 Date Issued: 22 November 2018
*With Explanation: Yes  No

SUBSCRIBED AND SWORN to before me this 05 day of January 2019, affiant exhibiting to me the above-stated
government issued identification card.

MAJ HANS OLIVER G BEARNEZA (INF) PA

(Name and Position of Administering

Page 2 of _____