SWORN STATEMENT OF ASSETS. LIABILITIES AND NET WORTH (Sample additional sheet/ for the exclusive propertics of the declarant’s spouse andl unmarried children ‘elow eighteen (18) years of age living in declarant’s household) | maser: 7 rosmriox ae ae rs Re Aorncyorricr ane ASSETS, LIABILITIES AND NET WORTH | Scanned with CamScannerRepublic of the Philippines NATIONAL POLICE COMMISSION PHILPPINENATIONALPOLICE, POLICE REGIONAL OFFICES REGIONAL PERSONNEL AND RECORDS! ‘DIVISION Camp BGen Simeon A Ola, Legazpi City MEMORANDUM TO : See Distribution FROM =: C,RPRMD SUBJECT : Submission of Statement of Assets, Liabilities and Net Worth (SALN) for CY 2022 DATE __: December 12, 2022 1. References: a, Memorandum from TDPRM dated December 9, 2022 treating the same Subject subject as above; 3 entitled “An Act Establishing a Code of b. Republic Act (RA) No. 671: c va fred of Public Officials and Employees” dated ‘conduct and Ethical Standard February 29, 1989; and 067 Revised Guidelines and c. PNP Memorandum Circular No. 2017- bilities and Net Procedures on the Filing of Statement of Asset, Lia Worth (SALN). 2. This pertains to the submission of SALN of all PNP personnel for CY 2022 as required by RA 6713. 3. In this regard, all Offices/Units are hereby directed to submit the consolidated and duly accomplished SALNs in soft copy (Attn: MWPPS) through email address p! @yahoo.com and two hard copies to this office NLT 42:00 NN of February 16, 2028 following the guidelines and procedures stated in PNP MC No. 2017-067: ’2._ List of Filers and Non-Filers (prepared in google sheet, alphabeticaly arranged regardless of ranks); 4) Third Level (All Offices/Units); and 2) Second Level down to NUP (All Offices/Units). (fete: Attach pstitcation and suppering documents fr non fers cr wih complete data andthe action taken ‘paren apt Duly accomplished SALN form (Hard Copy); 1) Third Level; and 2) Second Level down to NUP s . Certificate duly signed by the Review and Compliance Committee of respective Office/Unit for Second Level down to NUP anf Third level for the filers and non-filers; and 9 “Life is Beautiful... Kaligtasan Nyo, Sagot ko. Tulong-tulong Tayo.” Scanned with CamScanner4. Certificate of Compliance (COC) sas conan oe (Note Concerned Onice/Unit submit thes COC upon completion ofthe | - (lt Career Once at A cate aed Te et ‘e/subend their SALN to compty wae "cant oy (20) aay rom rece of the 80 al SC HE He 3 Soc 3 som 201) Service Commission SALN data for uniformity of e 4. Attached are the copies of the revised Civil ‘orm 2015 and the prescribed formats for other required 5. For guidance and strict compliance. ‘O16, RMFES: Copy Furnished: RO & Command Group avon Scanned with CamScanneri- ———— —— ——— Repuene ofthe Phecores UNTO Natone! Poice Commission 180 {Office/ nit eddress; CERTIFICATE OF COMPLIANCE SALN Submission’ iling Ths certties tat emotoyens tt invoice (5" Lowel) covered by RA 6713 have fed fe Swom Statement of Assats. Liabilities and Net Worth and era Finance! Conrectore (SALN end DBIFC) for CY 20_ The Agency = forwardedimied a SALNe wit the appropnate receving enety (© OTPUISTEN = case of Presigent, Vice President and Constitutional Officials. #16 wm accordance win me RAG713 and its implementing rules and reguiatons ‘Th elo attests nat the submission ofthis agency's emosoyees have subsranhaly compled wih the minimum requistes for content end formalities prescribed unde” Rentne Act 6713 and its implementing Rules and Reguiations, wruch are {oiows Basic Information Assets (Real Properties and Personal Properties) Liabrites Net Worth Finanesal Connections and Business interests Relatives in the Government se ance IN WITNESS WHEREOF, we have hereunto affixed our signature on the __ Gay zi i Year 20_ Philippines CHAIRMAN 708 SALN Review and Compliance Committee tthe Agency/Department Head ( Scanned with CamScanner ’a ‘= =. — Reoupie of fhe Phikpnines UNIVORICE National Police Commission Hits ——CfliceUnii addres) CERTIFICATE OF COMPLIANCE SALN Submission/Filing Ths cervtes that employees cut of ___ employees of ——[uewOrice) ________. (2 Level) covered by RA 6713 have filed their Sworn Statement of Assets, Liabilities and Net Wortn and Disclosure of Business Interest and Financial Connections (SALN and DBIFC) for CY 20__. The Agency has forwarded/fied all SALNs with the appropriate receiving entity (ie Ombudsman in the case of President, Vice President and Constitutona! Officials; etc.. in accordance with the RA 6713 and its implementing rules and regulations Ths also attests that the submission of this agency's employees have Substantially complied with the minimum requisites for content and formalities prescribed under Republic Act 6713 and its implementing Rules and Regulations, which are follows: Basic Information Assets (Real Properties and Personal Properties) Liabilities Net Worth, Financial Connections and Business Interests Relatives in the Government seange Lastly, this certifies that this agency has already executed appropriste action aganst those who failed te comply with RA 6713 and have no justifiable reason not to ‘comply INWATNESS WHEREOF, we have hereunto atfred our signature on the __day of__, Year 20__at Philippines. AGENCY SALN Review and Compliance Committeo itHend( ’ Scanned with CamScannerOFFICE/UNIT | Statement of Assets, Liabilities and Networth | unirrorrice | Calendar Year 20__ 1060 Filers: | | Ncenenescnnemee CERTIFICATION This is to certity that the SALNs submitted/included in the Summary List of Filers (2 and 3° Level) were reviewed and found compliant by the Review and Compliance Committee of this Office Further the review were made in accordance with the review and compliance procedure in filing and submission of SALN’s pursuant to CSC Memorandum Circular No 10, s 2006 (as amended by CSC Resolution No. 1300455 promulgated ‘on March 4, 2013). lesued on mavadivy. a K/Name ‘Compliance Committee SALN eS ———_(einaae)__ ‘Member Member Review and Compliance Committee Review and Compliance Committee Scanned with CamScannereS UNTT/OFFICE i ‘Statement of Assets, Liabilities and Networh | ow Calendar Year 20 | UNETIOFFICE | NP Non- Filers tos0 CERTIFICATION This is to certify that the SALNs submitted/included in the Summary List of Non-Filers (2 and 3° Level) were reviewed and found non-compliant by the Review and Compliance Committee of this Office Further the review were made in accordance with the review and compliance procedure in filing and submission of SALN’s pursuant to CSC Memorandum Circular No. 10, 8. 2006 (as amended by CSC Resolution No. 1300455 promulgated ‘on March 4, 2013) 'ssued on mm/s (signature! RankName Chairperson, Review and Compliance Committee SALN ‘signature signature) ‘Member ‘Member Review and Compliance Committee Review and Compliance Committee Scanned with CamScannerScanned with CamScannerScanned with CamScannerScanned with CamScannerScanned with CamScannerScanned with CamScannerSWORN STATEMENT OF ASSETS. LIABILITIES AND NET WORTH ‘Aso: (Requeed be RA 67a ete: Hasta ad unt who are beth pbc afals and emploes may ithe repute tctements hyo separately S vownt Filing D Separate Filing Not Applicable (Including those of the spouse and unmarried children below eighteen (18) years: of age tving in declarant’ househot) * Additional shoet/s may be used, if necessary. Pave 1 of Scanned with CamScanner‘TOTAL LIABILITIES: ET WORTH : Total Assets less Total Liabilities + Additional sheet/s may be used. necessary BUSINESS INTERESTS AND FINANCIAL CONNECTION: (of Drctaant /Dectarant’sspmese/ Unmanned Clem Rein Baghtcen (18 gars of Aa Laing in Dechrant's Mensch Q./We do not have any business interest or financial connection | pare oF acouisrmion oF | [ ren on commecrion RELATIVES IN THE GOVERNMENT SERVICE hon the Fourth Deore of Consangunay or Affinty Ince as Has. Baa andl se) 4 1/ We do not know of any relative/'s in the government service) business interests and financial connections, including those of my spouse and unmarried children belo cightcen (18) years of age living in my household, and that to the best of my knowledge. the above Chumeratea are names of my relatives in the government within the fourth civil degree of consanguinity or | 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 m houschold covering previous years to include the year I first assumed office in government. ‘Sars of Darah ~ ‘aaa of C> DekarantSpese) Careenment tied 1? ~~ (Person Administering Oath) Page 201 Scanned with CamScannerSWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH Scanned with CamScanner