2.

LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE

TOTAL LIABILITIES: -
NET WORTH: Total Assets Less Total Liabilities =

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

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 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, networth, business
interests and financial connections, including those of my spouse and unmarried children below eighteen
(18) years of age living in my household, and hat 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:

(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
 Revised as of January 2015
Per CSC Resolution No. 1500088
Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NETWORTH

As of December 3 1, 2022
(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: SAMBU ROMMEL G. POSITION: ADMINISTRATIVE AIDE I

(Family Name) (First Name) (M.I) AGENCY/OFFICE: LOCAL GOVERNMENT UNIT
ADDRESS: GUINATAN, CITY OF ILAGAN, ISABELA OFFICE ADDRESS: CITY OF ILAGAN, ISABELA

SPOUSE: SAMBU ELISA E. POSITION: TEACHER III

(Family Name) (First Name) (M.I) AGENCY/OFFICE: DEPARTMENT OF EDUCATION
OFFICE ADDRESS: BENITO SOLIVEN, ISABELA

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT'S HOUSEHOLD
NAME DATE OF BIRTH AGE
LIAM ROMWEL E. SAMBU NOVEMBER 23, 2009 13

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*

ASSESSED CURRENT FAIR

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

HOUSE RESIDENTIAL YEBAN NORTE 30,000 500,000 2020 Constructed 600,000.00

Subtotal: - 600,000.00

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT
Gadgets and appliances 2022 100,000.00
Motorcycle 2022 79,200.00

Subtotal: 179,200.00

TOTAL ASSETS (a+b): 779,200.00

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

Page 1 of 2
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
Salary Loan DBP 78,400.00

TOTAL LIABILITIES: 78,400.00

NET WORTH: Total Assets Less Total Liabilities = 700,800.00

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

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 ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF
ENTERPRISE INTEREST &/OR FINANCIAL INTEREST OR CONNECTION
CONNECTION

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

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

MA. ELENA S. AURELLANO SISTER DESK SUPERVISOR NATIONAL STATISTICS OFFICE-MANILA

ROEHL A. MANALO BROTHER-IN-LAW ADMIN.AIDE I LGU, CITY OF ILAGAN, ISABELA

EDEN E. MIRASOL SISTER-IN-LAW TEACHER III DEPARTMENT OF EDUCATION-B. SOLIVEN,

I hereby certify that these are true and correct statements of my assets, liabilities, networth, business
interests and financial connections, including those of my spouse and unmarried children below eighteen
(18) years of age living in my household, and hat 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: APRIL 13, 2023

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

Government Issued ID: Employee ID Government Issued ID: GSIS
ID No.: 21-1206 ID No.: CRN-006-0070-1101-2
Date Issued: N/A Date Issued: N/A

SUBSCRIBED AND SWORN to before me this 13th day of April, 2023, affiant exhibiting
to me the above-stated government issued identification card.

(Person Administering Oath)

Page 2 of 2
 Revised as of January 2015
Per CSC Resolution No. 1500088
Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NETWORTH

As of December 31, 2021
(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:
(Family Name) (First Name) (M.I) AGENCY/OFFICE:
ADDRESS: OFFICE ADDRESS:

SPOUSE: POSITION:
(Family Name) (First Name) (M.I) 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*

ASSESSED CURRENT FAIR

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

Subtotal: - -

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT

Subtotal: -

TOTAL ASSETS (a+b): -

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

Page 1 of 2
 Revised as of January 2015
Per CSC Resolution No. 1500088
Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NETWORTH

As of December 31, 2022
(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: SAMBU ELISA E. POSITION: TEACHER 3

(Family Name) (First Name) (M.I) AGENCY/OFFICE: DEPARTMENT OF EDUCATION
ADDRESS: YEBAN NORTE, BENITO SOLIVEN, ISABELA OFFICE ADDRESS: BENITO SOLIVEN, ISABELA

SPOUSE: SAMBU ROMMEL G. POSITION: ADMINISTRATIVE AIDE I

(Family Name) (First Name) (M.I) AGENCY/OFFICE: LOCAL GOVERNMENT UNIT
OFFICE ADDRESS: CITY OF ILAGAN, ISABELA

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT'S HOUSEHOLD
NAME DATE OF BIRTH AGE
LIAM ROMWEL E. SAMBU NOVEMBER 23, 2009 13

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*

ASSESSED CURRENT FAIR

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

HOUSE RESIDENTIAL YEBAN NORTE 30,000 500,000 2020 Constructed 600,000.00

Subtotal: - 600,000.00

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT
Gadgets and appliances 2022 100,000.00
Motorcycle 2022 79,200.00

Subtotal: 179,200.00

TOTAL ASSETS (a+b): 779,200.00

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

Page 1 of 2
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
Multipurpose Loan GSIS 287,627.98
MTSLA-Secured Loan MTMAS 457,822.26

TOTAL LIABILITIES: 745,450.24

NET WORTH: Total Assets Less Total Liabilities = 33,749.76

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

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 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

MA. ELENA S. AURELLANO SISTER-IN-LAW DESK SUPERVISOR PHILIPPINESTATISTICS OFFICE-MANILA

TEODORA B. GINEZ AUNT TEACHER III DEPARTMENT OF EDUCATION-B. SOLIVEN

EDEN E. MIRASOL SISTER TEACHER III DEPARTMENT OF EDUCATION-B. SOLIVEN

I hereby certify that these are true and correct statements of my assets, liabilities, networth, business
interests and financial connections, including those of my spouse and unmarried children below eighteen
(18) years of age living in my household, and hat 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: FEBRUARY 15, 2023

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

Government Issued ID: GSIS Government Issued ID: Employee ID
ID No.: CRN-006-0070-1101-2 ID No.: 21-1206
Date Issued: N/A Date Issued: N/A

SUBSCRIBED AND SWORN to before me this 15th day of February, 2023, affiant exhibiting
to me the above-stated government issued identification card.

BONIFACIO M. VIERNES JR.

Barangay Captain
(Person Administering Oath)

Page 2 of 2
 Revised as of January 2015
Per CSC Resolution No. 1500088
Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NETWORTH

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: LAGUA MICHELLE Q. POSITION: TEACHER III

(Family Name) (First Name) (M.I) AGENCY/OFFICE: DEPARTMENT OF EDUCATION
ADDRESS: YEBAN NORTE, BENITO SOLIVEN, ISABELA OFFICE ADDRESS: BENITO SOLIVEN, ISABELA

SPOUSE: LAGUA JULIUS C. POSITION: ASSISTANT PROFFESOR IV

(Family Name) (First Name) (M.I) AGENCY/OFFICE: ISABELA STATE UNIVERSITY
OFFICE ADDRESS: STA. FILOMENA, SAN MARIANO
ISABELA

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT'S HOUSEHOLD
NAME DATE OF BIRTH AGE
KENT ZURIEL Q. LAGUA DECEMBER 25, 2008 15 YRS. OLD
KATE ZYRIEL Q. LAGUA JANUARY 7, 2013 11 YRS. OLD
KENDRA ZIENNA Q. LAGUA DECEMBER 17, 2014 9 YRS.OLD

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*

ASSESSED CURRENT FAIR

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

HOUSE RESIDENTIAL YEBAN NORTE 68,650 343,272.00 2018 Construction 800,000.00

LOT RESIDENTIAL YEBAN NORTE 71,820 359,091.00 2018 Inheritance -

Subtotal: - 800,000.00

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT
Appliances 2019 50,000.00
Furniture and fixtures 2019 200,000.00
Laptop and gadgets 2020 55,000.00
Car 2023 1,600,000.00

Subtotal: 1,905,000.00

TOTAL ASSETS (a+b): 2,705,000.00

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

Page 1 of 2
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
Government Institution GSIS 311,796.0
Private Lending Institution BDO 500,000.00
Private Lending Institution China Bank 1,000,000.0

TOTAL LIABILITIES: 1,811,796.00

NET WORTH: Total Assets Less Total Liabilities = 893,204.00

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

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 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, networth, business
interests and financial connections, including those of my spouse and unmarried children below eighteen
(18) years of age living in my household, and hat 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: January 31,2024

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

Government Issued ID: GSIS Government Issued ID: PIC (Agriculturist)
ID No.: 006-0031-0524-9 ID No.: 179
Date Issued: 9/27/2007 Date Issued: 8/15/2003

SUBSCRIBED AND SWORN to before me this 31st day of January 2024, affiant exhibiting
to me the above-stated government issued identification card.

BONIFACIO M. VIERNES JR.

Barangay Captain
(Person Administering Oath)

Page 2 of 2
 Revised as of January 2015
Per CSC Resolution No. 1500088
Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NETWORTH

As of December 31, 2021
(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: DALIT IMELDA L. POSITION: TEACHER III

(Family Name) (First Name) (M.I) AGENCY/OFFICE: DEPARTMENT OF EDUCATION
ADDRESS: YEBAN NORTE, BENITO SOLIVEN, ISABELA OFFICE ADDRESS: BENITO SOLIVEN, ISABELA

SPOUSE: N/A POSITION:

(Family Name) (First Name) (M.I) AGENCY/OFFICE:
OFFICE ADDRESS:

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT'S HOUSEHOLD
NAME DATE OF BIRTH AGE
PRECIOUS MAXINE D. MARTIN 9/23/2003 18
JANNA KATLEYA D. MARTIN 3/22/2005 16

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*

ASSESSED CURRENT FAIR

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

House
Residential Yeban Norte 2017 Construction 150,000.00
Improvement

House
Residential Yeban Norte 2020 Construction 80,000.00
Improvement

Subtotal: - 230,000.00

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT
LAPTOP 2019 21,000.00
CELLPHONE 2018 15,000.00
FURNITURES 2016 50,000.00

Subtotal: 86,000.00

TOTAL ASSETS (a+b): 316,000.00

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

Page 1 of 2
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
CONSOLIDATED LOAN GSIS 200,000.00
CHARACTER LOAN PRIVATE 65,000.00

TOTAL LIABILITIES: 265,000.00

NET WORTH: Total Assets Less Total Liabilities = 51,000.00

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

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 ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF
ENTERPRISE INTEREST &/OR FINANCIAL INTEREST OR CONNECTION
CONNECTION

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

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

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

I hereby certify that these are true and correct statements of my assets, liabilities, networth, business
interests and financial connections, including those of my spouse and unmarried children below eighteen
(18) years of age living in my household, and hat 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: JANUARY 31, 2022

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

Government Issued ID: GSIS Government Issued ID:
ID No.: 20003946260 ID No.:
Date Issued: N/A Date Issued:

SUBSCRIBED AND SWORN to before me this 31st day of January, 2022, affiant exhibiting
to me the above-stated government issued identification card.

MARIBEL C. CACAYAN,EdD
School District Supervisor
(Person Administering Oath)

Page 2 of 2
 Revised as of January 2015
Per CSC Resolution No. 1500088
Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NETWORTH

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: IQUIN MILAGROS L. POSITION: TEACHER III

(Family Name) (First Name) (M.I) AGENCY/OFFICE: DEPARTMENT OF EDUCATION
ADDRESS: YEBAN NORTE, BENITO SOLIVEN, ISABELA OFFICE ADDRESS: BENITO SOLIVEN, ISABELA

SPOUSE: IQUIN EDUARDO B. POSITION: N/A

(Family Name) (First Name) (M.I) AGENCY/OFFICE: N/A
OFFICE ADDRESS: N/A

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT'S HOUSEHOLD
NAME DATE OF BIRTH AGE
N/A N/A N/A

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*

ASSESSED CURRENT FAIR

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

HOUSE Residential Yeban Norte 75,000 100,000 2022 Improvement 200,000

LOT Residential Yeban Norte 87,000 100,000 2000 Purchased 87,000.00

Subtotal: - 287,000.00

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT
APPLIANCES 10,000.00
LAPTOP 21,000.00
VAN 150,000.00

Subtotal: 181,000.00

TOTAL ASSETS (a+b): 468,000.00

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

Page 1 of 2
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
CONSOLIDATED LOAN GSIS 165,369.65
EDUCATIONAL LOAN MANILA TEACHERS 20,000.00
CALAMITY LOAN PAG-IBIG 11,799.00
AGRICULTURAL LOAN CITY SAVINGS BANK 120,000.00
TOTAL LIABILITIES: 317,168.65
NET WORTH: Total Assets Less Total Liabilities = 150,831.35

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

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 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

LERMA T. LANGUIDO COUSIN TEACHER III DEPARTMENT OF EDUCATION-BENITO SOLIVEN

ROSANA P. ABON COUSIN TEACHER III DEPARTMENT OF EDUCATION-BENITO SOLIVEN

I hereby certify that these are true and correct statements of my assets, liabilities, networth, business
interests and financial connections, including those of my spouse and unmarried children below eighteen
(18) years of age living in my household, and hat 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:

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

Government Issued ID: PRC Government Issued ID: Driver's License
ID No.: 319476 ID No.: B02-89-021678
Date Issued: 2/26/1998 Date Issued: 2/13/2018

SUBSCRIBED AND SWORN to before me this ________ day of _____________, 2023, affiant exhibiting
to me the above-stated government issued identification card.

FORTUNATA J. BALISI
Public Schools District Supervisor
(Person Administering Oath)

Page 2 of 2
 Revised as of January 2015
Per CSC Resolution No. 1500088
Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NETWORTH

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: AGUILAR ARCELY J. POSITION: TEACHER III

(Family Name) (First Name) (M.I) AGENCY/OFFICE: DEPARTMENT OF EDUCATION
ADDRESS: YEBAN NORTE, BENITO SOLIVEN, ISABELA OFFICE ADDRESS: BENITO SOLIVEN, ISABELA

SPOUSE: AGUILAR DELFIN P. POSITION: N/A

(Family Name) (First Name) (M.I) AGENCY/OFFICE:
OFFICE ADDRESS:

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT'S HOUSEHOLD
NAME DATE OF BIRTH AGE
N/A N/A N/A

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*

ASSESSED CURRENT FAIR

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

HOUSE Residential Yeban Norte 17,788 296,471.00 2022 Improvement 296,471.00

LOT Residential Yeban Norte 1,200 20,000.00 1997 Inherited

Subtotal: - 296,471.00

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT
LAPTOP 2019 19,900.00
CASH ON HAND 2023 80,000.00
MOTORCYCLE/S 2019 95,000.00
FURNITURES 19,922,012 45,000.00
APPLIANCES 1990-2014 90,000.00
OVEN/OTHER BAKERY EQUIPMENTS 2018-2020 117,000.00
Subtotal: 446,900.00

TOTAL ASSETS (a+b): 743,371.00

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

Page 1 of 2
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
CONSOLIDATED LOAN GSIS 458,640.00
MULTI-PURPOSE LOAN MTSLA 111,550.00

TOTAL LIABILITIES: 570,190.00

NET WORTH: Total Assets Less Total Liabilities = 173,181.00

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

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 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

ROWENA J. VALDEZ SISTER TEACHER I DEPARTMENT OF EDUCATION-BENITO SOLIVEN

I hereby certify that these are true and correct statements of my assets, liabilities, networth, business
interests and financial connections, including those of my spouse and unmarried children below eighteen
(18) years of age living in my household, and hat 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:

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

Government Issued ID: PRC Government Issued ID: GSIS
ID No.: 1229011 ID No.: 066-0063-9697-4
Date Issued: 7/13/2015 Date Issued: N/A

SUBSCRIBED AND SWORN to before me this ________ day of _____________, 2023, affiant exhibiting
to me the above-stated government issued identification card.

FORTUNATA J. BALISI
Public Schools District Supervisor
(Person Administering Oath)

Page 2 of 2
 Revised as of January 2015
Per CSC Resolution No. 1500088
Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NETWORTH

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: ESTEBAN RELIZA A. POSITION: TEACHER III

(Family Name) (First Name) (M.I) AGENCY/OFFICE: DEPARTMENT OF EDUCATION
ADDRESS: YEBAN NORTE, BENITO SOLIVEN, ISABELA OFFICE ADDRESS: BENITO SOLIVEN, ISABELA

SPOUSE: ESTEBAN HERMOGENES JR. M. POSITION: N/A

(Family Name) (First Name) (M.I) AGENCY/OFFICE: N/A
OFFICE ADDRESS: N/A

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT'S HOUSEHOLD
NAME DATE OF BIRTH AGE
PRECIOUS YZA A. ESTEBAN 06-28-2011 10

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*

ASSESSED CURRENT FAIR

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

23,240.00
HOUSE Residential Yeban Norte 23,240.00 15-04- 2009 Constructed 450,000.00
0028-01419

Subtotal: - 450,000.00

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT
FURNITURE 2008, 2011 57,000.00
PRINTER 2013 7,200.00
HAND TRACTOR 2019 85,000.00
CORN PLANTER 2019 34,000.00
TELEVISION 2020 25,000.00

Subtotal: 208,200.00

TOTAL ASSETS (a+b): 658,200.00

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

Page 1 of 2
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
CONSOLIDATED LOAN GSIS 237,354.15
COMPUTER LOAN GSIS 9,833.30
MULTI PURPOSE LOAN PAGIBIG 43,371.53.00
REGULAR LOAN MTMAS 145,350.00

TOTAL LIABILITIES: 392,537.45

NET WORTH: Total Assets Less Total Liabilities = 265,662.55

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

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 ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF
ENTERPRISE INTEREST &/OR FINANCIAL INTEREST OR CONNECTION
CONNECTION

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

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

ADMINISTRATIVE
ROEL P. AGUSTIN BROTHER ASSISTANT III DEPARTMENT OF EDUCATION-BENITO SOLIVEN

RELSON P. AGUSTIN BROTHER TEACHER III DEPARTMENT OF EDUCATION-BENITO SOLIVEN

VIRGINIA B. AGUSTIN SISTER IN-LAW MIDWIFE II DEPARTMENT OF HEALTH-BENITO SOLIVEN

JOCELYN V. AGUSTIN SISTER IN-LAW TEACHER III DEPARTMENT OF EDUCATION-BENITO SOLIVEN

ROBERT M. ESTEBAN BROTHER IN-LAWPERMIT AND LICENSING OFFICER

BUSINESS LOCAL GOVERNMENT UNIT-BENITO SOLIVEN

I hereby certify that these are true and correct statements of my assets, liabilities, networth, business
interests and financial connections, including those of my spouse and unmarried children below eighteen
(18) years of age living in my household, and hat 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: 1/31/2024

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

Government Issued ID: PRC Government Issued ID: N/A
ID No.: 612662 ID No.: N/A
Date Issued: 11-15-1999 Date Issued: N/A

SUBSCRIBED AND SWORN to before me this 31st day of January, 2024, affiant exhibiting
to me the above-stated government issued identification card.

(Person Administering Oath)

Page 2 of 2
 Revised as of January 2015
Per CSC Resolution No. 1500088
Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NETWORTH

As of December 31, 2021
(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: ESTEBAN FELICIDAD A. POSITION: MASTER TEACHER I

(Family Name) (First Name) (M.I) AGENCY/OFFICE: DEPARTMENT OF EDUCATION
ADDRESS: YEBAN NORTE, BENITO SOLIVEN, ISABELA OFFICE ADDRESS: BENITO SOLIVEN, ISABELA

SPOUSE: ESTEBAN ROLANDO V. POSITION: N/A

(Family Name) (First Name) (M.I) AGENCY/OFFICE: N/A
OFFICE ADDRESS: N/A

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT'S HOUSEHOLD
NAME DATE OF BIRTH AGE
N/A N/A N/A
N/A N/A N/A
N/A N/A N/A
N/A N/A N/A

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*

ASSESSED CURRENT FAIR

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

HOUSE Residential Yeban Norte 95,000.00 180,000.00 1995 REPAIR 95,000.00

Subtotal: - 95,000.00

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT
1 UNIT HONDA MOTORCYCLE 2010 91,000.00
APPLIANCES/FURNITURE 1999-2014 92,500.00

Subtotal: 183,500.00

TOTAL ASSETS (a+b): 278,500.00

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

Page 1 of 2
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
CONSOLIDATED LOAN GSIS 210,586.00

TOTAL LIABILITIES: 210,586.00

NET WORTH: Total Assets Less Total Liabilities = 67,914.00

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

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 ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF
ENTERPRISE INTEREST &/OR FINANCIAL INTEREST OR CONNECTION
CONNECTION

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

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

ROBERT M. ESTEBAN COUSIN HRMO ASSISTANT LOCAL GOVERNMENT UNIT-BENITO SOLIVEN

DONNABEL M. JUSTO NIECE MUN. SEC LOCAL GOVERNMENT UNIT-BENITO SOLIVEN

ELIZABETH A. SALAGUINTO SISTER TEACHER I DEPARTMENT OF EDUCATION-BENITO SOLIVEN

I hereby certify that these are true and correct statements of my assets, liabilities, networth, business
interests and financial connections, including those of my spouse and unmarried children below eighteen
(18) years of age living in my household, and hat 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: JANUARY 31, 2022

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

Government Issued ID: PRC -0142785 Government Issued ID: N/A
ID No.: 341961 ID No.: N/A
Date Issued: 09-19-1997 Date Issued: N/A

SUBSCRIBED AND SWORN to before me this 31st day of January, 2022, affiant exhibiting
to me the above-stated government issued identification card.

MARIBEL C. CACAYAN,EdD
School District Supervisor
(Person Administering Oath)

Page 2 of 2
 Revised as of January 2015
Per CSC Resolution No. 1500088
Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NETWORTH

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: VIERNES LEONIDA B. POSITION: TEACHER III

(Family Name) (First Name) (M.I) AGENCY/OFFICE: DEPARTMENT OF EDUCATION
ADDRESS: YEBAN NORTE, BENITO SOLIVEN, ISABELA OFFICE ADDRESS: BENITO SOLIVEN, ISABELA

SPOUSE: VIERNES AMADO G. POSITION: SB MEMBER

(Family Name) (First Name) (M.I) AGENCY/OFFICE: LOCAL GOVERNMENT UNIT
OFFICE ADDRESS: BENITO SOLIVEN, ISABELA

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT'S HOUSEHOLD
NAME DATE OF BIRTH AGE
N/A N/A N/A
N/A N/A N/A
N/A N/A N/A
N/A N/A N/A

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*

ASSESSED CURRENT FAIR

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

121,940.00
HOUSE Residential Yeban Norte -
15-24-0028
1993 Construction 300,000.00

69,000.00
LOT Residential Yeban Norte 4,140 15-04-0028- 1993 PURCHASE 5,000.00
00974

Subtotal: - 305,000.00

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT
FURNITURES 9,000.00
FURNITURES 3,500.00

Subtotal: 12,500.00

TOTAL ASSETS (a+b): 317,500.00

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

Page 1 of 2
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
CONSOLIDATED LOAN GSIS 291,596.73
SALARY LOAN MANILA TEACHERS 107,547.61

TOTAL LIABILITIES: 399,144.34

NET WORTH: Total Assets Less Total Liabilities =

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

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 ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF
ENTERPRISE INTEREST &/OR FINANCIAL INTEREST OR CONNECTION
CONNECTION

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

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

PATRICIO S. BALBIN BROTHER TEACHER III DEPARTMENT OF EDUCATION-BENITO SOLIVEN

I hereby certify that these are true and correct statements of my assets, liabilities, networth, business
interests and financial connections, including those of my spouse and unmarried children below eighteen
(18) years of age living in my household, and hat 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: 1/31/2024

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

Government Issued ID: PRC Government Issued ID: LGU ID
ID No.: 104752 ID No.: 38
Date Issued: 8-25-1997 Date Issued: N/A

SUBSCRIBED AND SWORN to before me this 31st day of January, 2024, affiant exhibiting
to me the above-stated government issued identification card.

MARIBEL C. CACAYAN,EdD
School District Supervisor
(Person Administering Oath)

Page 2 of 2
 Revised as of January 2015
Per CSC Resolution No. 1500088
Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NETWORTH

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: MARTIN NOVELITA V. POSITION: TEACHER III

(Family Name) (First Name) (M.I) AGENCY/OFFICE: DEPARTMENT OF EDUCATION
ADDRESS: YEBAN NORTE, BENITO SOLIVEN, ISABELA OFFICE ADDRESS: BENITO SOLIVEN, ISABELA

SPOUSE: MARTIN DIONISIO R. POSITION: N/A

(Family Name) (First Name) (M.I) AGENCY/OFFICE: N/A
OFFICE ADDRESS: N/A

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT'S HOUSEHOLD
NAME DATE OF BIRTH AGE
N/A N/A N/A

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*

ASSESSED CURRENT FAIR

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

LOT Residential Yeban Norte 12,000.00 200,000.00 1994 PURCHASED 50,000.00

HOUSE Residential Yeban Norte - 73,260.00 1994 CONSTRUCTION 350,000.00

Subtotal: - 400,000.00

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT
APPLIANCES 2022 24,000.00
FURNITURE 1992 30,000.00
HONDA TMX SUPREMO 2014 54,000.00

Subtotal: 108,000.00

TOTAL ASSETS (a+b): 508,000.00

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

Page 1 of 2
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
CONSOLIDATED LOAN GSIS 268,266.51
REGULAR LOAN MTMAS 149,773.77

TOTAL LIABILITIES: 418,040.28

NET WORTH: Total Assets Less Total Liabilities = 89,959.72

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

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 ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS INTEREST DATE OF ACQUISITION OF
ENTERPRISE &/OR FINANCIAL CONNECTION INTEREST OR 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

CHARIZA V. MARTIN DAUGHTER TEACHER I DEPARTMENT OF EDUCATION-BENITO SOLIVEN

ROSALINA B. LANGUIDO COUSIN MASTER TEACHER II DEPARTMENT OF EDUCATION-BENITO SOLIVEN

I hereby certify that these are true and correct statements of my assets, liabilities, networth, business
interests and financial connections, including those of my spouse and unmarried children below eighteen
(18) years of age living in my household, and hat 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: JANUARY 31, 2023

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

Government Issued ID: PRC Government Issued ID: Driver's License
ID No.: 245025 ID No.: B02-95-035915
Date Issued: 12-16-1997 Date Issued: 12/7/2018

SUBSCRIBED AND SWORN to before me this 31st day of January, 2023, affiant exhibiting
to me the above-stated government issued identification card.

BONIFACIO M. VIERNES JR.

Barangay Captain
(Person Administering Oath)

Page 2 of 2
 Revised as of January 2015
Per CSC Resolution No. 1500088
Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NETWORTH

As of December 31, 2021
(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: JUSTO ERLINDA P. POSITION: TEACHER III

(Family Name) (First Name) (M.I) AGENCY/OFFICE: DEPARTMENT OF EDUCATION
ADDRESS: YEBAN NORTE, BENITO SOLIVEN, ISABELA OFFICE ADDRESS: BENITO SOLIVEN, ISABELA

SPOUSE: JUSTO RODELIO R. POSITION: N/A

(Family Name) (First Name) (M.I) AGENCY/OFFICE: N/A
OFFICE ADDRESS: N/A

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT'S HOUSEHOLD
NAME DATE OF BIRTH AGE
N/A N/A N/A
N/A N/A N/A
N/A N/A N/A
N/A N/A N/A

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*

ASSESSED CURRENT FAIR

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

LOT Residential Yeban Norte 11,980.00 199,640.00 1992 PURCHASE 100,000.00

HOUSE Residential Yeban Norte - 43,872.00 2011 RENOVATE 400,000.00

CORNFIELD Agricultural Yeban Norte 16,520 275.00 RENT 50,000.00

Subtotal: - 550,000.00

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT
APPLIANCES 1998 50,000.00
FURNITURES 1995 20,000.00
JEWELRIES 2000 5,000.00

Subtotal: 75,000.00

TOTAL ASSETS (a+b): 625,000.00

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

Page 1 of 2
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
CONSOLIDATED LOAN GSIS 200,000.00
EDUCATIONAL LOAN MANILA TEACHERS 100,000.00
PRIVATE LOAN CITY SAVINGS 50,000.00

TOTAL LIABILITIES: 350,000.00

NET WORTH: Total Assets Less Total Liabilities = 275,000.00

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

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 ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS INTEREST DATE OF ACQUISITION OF
ENTERPRISE &/OR FINANCIAL CONNECTION INTEREST OR CONNECTION

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

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

MA. LOURDES P. LORENZO SISTER TEACHER III DEPARTMENT OF EDUCATION-BENITO SOLIVEN

FELICIDAD A. ESTEBAN COUSIN MASTER TEACHER I DEPARTMENT OF EDUCATION-BENITO SOLIVEN

ARCELY J. AGUILAR SISTER-IN-LAW TEACHER III DEPARTMENT OF EDUCATION-BENITO SOLIVEN

I hereby certify that these are true and correct statements of my assets, liabilities, networth, business
interests and financial connections, including those of my spouse and unmarried children below eighteen
(18) years of age living in my household, and hat 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: JANUARY 31, 2022

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

Government Issued ID: PRC Government Issued ID: N/A
ID No.: 143784 ID No.: N/A
Date Issued: 11/9/2020 Date Issued: N/A

SUBSCRIBED AND SWORN to before me this 31st day of January, 2022, affiant exhibiting
to me the above-stated government issued identification card.

MARIBEL C. CACAYAN,EdD
School District Supervisor
(Person Administering Oath)

Page 2 of 2
 Revised as of January 2015
Per CSC Resolution No. 1500088
Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NETWORTH

As of December 31, 2021
(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: LANGUIDO MYRNA P. POSITION: TEACHER III

(Family Name) (First Name) (M.I) AGENCY/OFFICE: DEPARTMENT OF EDUCATION
ADDRESS: YEBAN NORTE, BENITO SOLIVEN, ISABELA OFFICE ADDRESS: BENITO SOLIVEN, ISABELA

SPOUSE: LANGUIDO SAMUEL M. POSITION: N/A

(Family Name) (First Name) (M.I) AGENCY/OFFICE: N/A
OFFICE ADDRESS: N/A

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT'S HOUSEHOLD
NAME DATE OF BIRTH AGE
N/A N/A N/A
N/A N/A N/A
N/A N/A N/A
N/A N/A N/A

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*

ASSESSED CURRENT FAIR

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

LOT Residential Yeban Norte 50,000.00 90,000.00 1995 Purchase 90,000.00

HOUSE Residential Yeban Norte 100,000 150,000.00 2000 Repair 150,000.00

Subtotal: - 240,000.00

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT
APPLIANCES 2017 70,000.00
FURNITURES 2016 50,000.00

Subtotal: 120,000.00

TOTAL ASSETS (a+b): 360,000.00

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

Page 1 of 2
2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

CONSOLIDATED LOAN GSIS 180,000.00
EDUCATIONAL LOAN MANILA TEACHERS 120,000.00

TOTAL LIABILITIES: 300,000.00

NET WORTH: Total Assets Less Total Liabilities = 60,000.00

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

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 ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS INTEREST DATE OF ACQUISITION OF
ENTERPRISE &/OR FINANCIAL CONNECTION INTEREST OR CONNECTION

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

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

ERLINDA P. JUSTO SISTER TEACHER III DEPARTMENT OF EDUCATION-BENITO SOLIVEN

FELICIDAD A. ESTEBAN COUSIN MASTER TEACHER I DEPARTMENT OF EDUCATION-BENITO SOLIVEN

EVANGELINE P. VERZOSA NIECE TEACHER III DEPARTMENT OF EDUCATION-BENITO SOLIVEN

I hereby certify that these are true and correct statements of my assets, liabilities, networth, business
interests and financial connections, including those of my spouse and unmarried children below eighteen
(18) years of age living in my household, and hat 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: JANUARY 31, 2020

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

Government Issued ID: PAG-IBIG Government Issued ID: DILG
ID No.: 1340-6015-7448 ID No.: 023104026-07
Date Issued: 10/10/2008 Date Issued: 11-30-2014

SUBSCRIBED AND SWORN to before me this 31st day of January, 2020, affiant exhibiting
to me the above-stated government issued identification card.

MARIBEL C. CACAYAN,EdD
School District Supervisor
(Person Administering Oath)

Page 2 of 2
 Revised as of January 2015
Per CSC Resolution No. 1500088
Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NETWORTH

As of December 31, 2021
(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: LORENZO MA. LOURDES P. POSITION: TEACHER III

(Family Name) (First Name) (M.I) AGENCY/OFFICE: DEPARTMENT OF EDUCATION
ADDRESS: YEBAN NORTE, BENITO SOLIVEN, ISABELA OFFICE ADDRESS: BENITO SOLIVEN, ISABELA

SPOUSE: LORENZO DANTE V. POSITION: FARMER

(Family Name) (First Name) (M.I) AGENCY/OFFICE:
OFFICE ADDRESS: YEBAN NORTE, BENITO SOLIVEN
ISABELA

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT'S HOUSEHOLD
NAME DATE OF BIRTH AGE
N/A N/A N/A
N/A N/A N/A
N/A N/A N/A
N/A N/A N/A

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*

ASSESSED CURRENT FAIR

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

CORNFIELD AGRICULTURAL Yeban Norte 53,330.00 76,183.00 1989 PURCHASED 50,000.00

HOUSE AND PURCHASED &

LOT
Residential Yeban Norte 2,480 4,400.00 1988 REPAIR 55,000.00

Subtotal: - 105,000.00

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT
FURNITURES 1990 45,000.00
APPLIANCES 1995 55,000.00

Subtotal: 100,000.00

TOTAL ASSETS (a+b): 205,000.00

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

Page 1 of 2
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
CONSOLIDATED LOAN GSIS 100,000.00
OTHERS 30,000.00
PERSONAL 10,000.00

TOTAL LIABILITIES: 140,000.00

NET WORTH: Total Assets Less Total Liabilities = 65,000.00

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

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 ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS INTEREST DATE OF ACQUISITION OF
ENTERPRISE &/OR FINANCIAL CONNECTION INTEREST OR CONNECTION

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

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

LEA MARIE R. ROSAS NIECE MASTER TEACHER I DEPARTMENT OF EDUCATION-BENITO SOLIVEN

I hereby certify that these are true and correct statements of my assets, liabilities, networth, business
interests and financial connections, including those of my spouse and unmarried children below eighteen
(18) years of age living in my household, and hat 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: JANUARY 31, 2022

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

Government Issued ID: PRC Government Issued ID: N/A
ID No.: 245024 ID No.: N/A
Date Issued: 12-16-1997 Date Issued: N/A

SUBSCRIBED AND SWORN to before me this 31st day of January, 2022, affiant exhibiting
to me the above-stated government issued identification card.

MARIBEL C. CACAYAN,EdD
School District Supervisor
(Person Administering Oath)

Page 2 of 2
 Revised as of January 2015
Per CSC Resolution No. 1500088
Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NETWORTH

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: LANGUIDO ROSALINA B. POSITION: MASTER TEACHER II

(Family Name) (First Name) (M.I) AGENCY/OFFICE: DEPARTMENT OF EDUCATION
ADDRESS: YEBAN NORTE, BENITO SOLIVEN, ISABELA OFFICE ADDRESS: BENITO SOLIVEN, ISABELA

SPOUSE: LANGUIDO DANILO M. POSITION: N/A

(Family Name) (First Name) (M.I) AGENCY/OFFICE: N/A
OFFICE ADDRESS: N/A

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*

ASSESSED CURRENT FAIR

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

HOUSE Residential Yeban Norte 900,000.00 1,000,000.00 2013 CONSTRUCTION 1,200,000.00

LOT Agricultural Cauayan Ciy 38,780 555,030.00 1980 INHERITANCE

LOT Residential Yeban Norte 16,520 275,310.00 1988 PURCHASED 25,000.00

Subtotal: - 1,225,000.00

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT
FURNITURES 1995-2013 50,000.00
APPLIANCES 1998-2017 80,000.00
CAR 2013 1,200,000.00
MOTORCYCLE 2015 47,000.00

Subtotal: 1,377,000.00

TOTAL ASSETS (a+b): 2,602,000.00

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

Page 1 of 2
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
MULTI-PURPOSE LOAN PAG-IBIG 26,070.00
POLICY LOAN GSIS 31,464.00
CONSOLIDATED LOAN GSIS 411,114.00

TOTAL LIABILITIES: 468,648.00

NET WORTH: Total Assets Less Total Liabilities = 1,783,352.00

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

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 ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS INTEREST DATE OF ACQUISITION OF
ENTERPRISE &/OR FINANCIAL CONNECTION INTEREST OR CONNECTION

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

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

ARRIANE AMOUR B.
LANGUIDO DAUGHTER TEACHER III DEPARTMENT OF EDUCATION-BENITO SOLIVEN

ARISTOTLE B. LANGUIDO SON NURSE I DEPARTMENT OF HEALTH

I hereby certify that these are true and correct statements of my assets, liabilities, networth, business
interests and financial connections, including those of my spouse and unmarried children below eighteen
(18) years of age living in my household, and hat 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:

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

Government Issued ID: PRC Government Issued ID: N/A
ID No.: 0143-788 ID No.: N/A
Date Issued: 06-19-1997 Date Issued: N/A

SUBSCRIBED AND SWORN to before me this day of , 2023, affiant exhibiting

to me the above-stated government issued identification card.

School District Supervisor

(Person Administering Oath)

Page 2 of 2
 Revised as of January 2015
Per CSC Resolution No. 1500088
Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NETWORTH

As of December 31, 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 Filing Separate Filing Not Applicable

DECLARANT: POSITION:
(Family Name) (First Name) (M.I) AGENCY/OFFICE:
ADDRESS: OFFICE ADDRESS:

SPOUSE: POSITION:
(Family Name) (First Name) (M.I) 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*

ASSESSED CURRENT FAIR

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

Subtotal: - -

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT

Subtotal: -

TOTAL ASSETS (a+b): -

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

Page 1 of 2
2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

TOTAL LIABILITIES: -
NET WORTH: Total Assets Less Total Liabilities =

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

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 ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS INTEREST DATE OF ACQUISITION OF
ENTERPRISE &/OR FINANCIAL CONNECTION INTEREST OR 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, networth, business
interests and financial connections, including those of my spouse and unmarried children below eighteen
(18) years of age living in my household, and hat 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:

(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 , 2020, affiant exhibiting

to me the above-stated government issued identification card.

(Person Administering Oath)

Page 2 of 2