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 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: SERNAL SALGIE P. POSITION: TEACHER 1

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPED DIVISION OF CAMARINES SUR
ADDRESS: INAPATAN NABUA CAM.SUR OFFICE ADDRESS: SAN JOSE, PILI, CAMARINES SUR

SPOUSE: N/A N/A N/A 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

SAMUEL REGIE F. SERNAL 5/7/2007 16
GIELLAN JEAN B. SERNAL 8/7/2014 9
GHIECEL B. SERNAL 12/31/2016 7
CARLOS GABRIELLE B. SERNAL 3/2/2002 2

ASSETS, LIABILITIES, AND NET WORTH

(Including those of the spouse and unmarried children below eighteen (18)
years of age living in the declarant’s household)
1. ASSETS
a. Real Properties*

DESCRIPTION KIND EXACT ASSESSED CURRENT FAIR ACQUISITION ACQUISITION

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

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

Subtotal: N/A

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT

MOTORCYCLE YAMAHA MIO 125 VARIOUS YEARS 60,000.00

GADGETS, CLOTHING, SHOES VARIOUS YEARS 155,000.00
APPLIANCES, FURNITURE VARIOUS YEARS 125,000.00
RECEIVABLE, SAVINGS, AND CASH ON HAND VARIOUS YEARS 25,000.00
Subtotal : Php365,000.00

Php365,000.00
TOTAL ASSETS (a+b):
* Additional sheet/s may be used, if necessary.

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2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

SALARY LOAN MTMAS 35,000.00

SALARY LOAN CHINA BANK 65,000.00
SALARY LOAN CITY SAVINGS 42,000.00
SALARY LOAN EAST WEST 130,000.00
MULTI-PURPOSE LOAN GSIS 85,000.00
POLICY LOAN GSIS 13,000.00

TOTAL LIABILITIES: Php360,000.00

NET WORTH : Total Assets less Total Liabilities = Php5,000.00

* 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
NONE NONE NONE NONE

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, CESARIA S. BERNAL COUSIN TEACHER 1 DEPED DIVISION OF CAMARINES SUR
MA. ELENA S. BERMAL COUSIN TEACHER 1 DEPED DIVISION OF CAMARINES SUR
JOMELYN S. ABONAL COUSIN TEACHER 1 DEPED DIVISION OF CAMARINES SUR
-NOTHING FOLLOWS-

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, 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: ______________________________

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

Government Issued ID: GSIS-UMID Government Issued ID: N/A

ID No.: 000-1152-3723-4 ID No.: N/A
Date Issued: 7/18/2018 Date Issued: N/A

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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