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Sworn Statement of Assets, Liabilities and Net Worth

This document is a sworn statement of assets, liabilities, and net worth as required by law to be filed by public officials and employees in the Philippines as of December 2020. It includes sections for the declarant's personal details and position, assets such as real estate and personal property, liabilities, business interests, relatives in government, and signatures certifying the truth and accuracy of the statement.

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Bernalyn Sardon
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99 views3 pages

Sworn Statement of Assets, Liabilities and Net Worth

This document is a sworn statement of assets, liabilities, and net worth as required by law to be filed by public officials and employees in the Philippines as of December 2020. It includes sections for the declarant's personal details and position, assets such as real estate and personal property, liabilities, business interests, relatives in government, and signatures certifying the truth and accuracy of the statement.

Uploaded by

Bernalyn Sardon
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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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, 2020
(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: ANDRADA BERNALYN P. POSITION: TEACHER 1


(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPED/PEDRO C. SESE SR.MHS
ADDRESS: POB. BALUD, OFFICE ADDRESS: PAJO, BALUD, MASBATE
MASBATE

SPOUSE: SARDON MICHAEL V. POSITION: TEACHER 1


(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPED/PEDRO C. SESE SR.MHS
OFFICE ADDRESS: PAJO, BALUD, MASBATE

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S HOUSEHOLD

NAME DATE OF BIRTH AGE


NONE

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 FAIR ACQUISITION ACQUISITION


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

NONE

Subtotal:
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION


COST/AMOUNT

APPLIANCES and GADGETS 2017-2020 35,000.00


MOTORCYCLE 2017 & 2020 112,000.00
JEWELRIES, CLOTHING and OTHER PERSONAL BELONGINGS 2017-2020 40,000.00

Subtotal : 187,000.00

TOTAL ASSETS (a+b):


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

Page 1 of ___
2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

SALARY LOAN EASTWEST BANK 180,000.00


SALARY LOAN MTMAS 21, 363.00
SALARY LOAN GSIS CONSOLE LOAN 42, 529.53

TOTAL LIABILITIES: 218,000.00


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, 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: ______________________________

(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.

_______________________________________

Page 2 of ___
(Person Administering Oath)

Page 3 of ___

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