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 ________________________
(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: GIMAR TALILI A. POSITION: TEACHER I

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: MBHTE-BARMM/
MAGUINDANO I
ADDRESS: POBLACION BULUAN MAGUINADANAO OFFICE ADDRESS: SHARIFF AGUAK,
MAGUINDANAO

ASSETS, LIABILITIES AND NETWORTH

1. ASSETS
a. Real Properties*

DESCRIPTION KIND EXACT ASSESSED CURRENT ACQUISITION ACQUISITION

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

N/A N/A N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A N/A

Subtotal: 0
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT

LAPTOP 2021 15,000.00

MOTORCYCLE 2021 60,000
Subtotal : 75,000.00

TOTAL ASSETS (a+b): 75,000.00

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

2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

N/A N/A N/A

N/A N/A N/A
N/A N/A N/A
N/A N/A N/A
TOTAL LIABILITIES: N/A
NET WORTH : Total Assets less Total Liabilities =
* Additional sheet/s may be used, if necessary.

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 BUSINESS INTERESTS AND FINANCIAL CONNECTIONS
 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

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, 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 and net worth.

Date: ______________________________

(Signature of Declarant)

Government Issued ID: PRC-ID

ID No.: 1474255
Date Issued: 08/13/2016

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

_______________________________________
(Person Administering Oath)

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