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    SALN 2015 Form 1

    Uploaded by

    subidasagala
    This document is a sworn statement form that public officials and employees must submit declaring their assets, liabilities, net worth, business interests, financial connections, and relatives in government service. The form includes sections for the declarant and spouse's personal details, a list of assets and liabilities, business interests, relatives in government, and a certification that the information provided is true and accurate. It authorizes the Ombudsman to access supporting documentation from government agencies.

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    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd

    SALN 2015 Form 1

    Uploaded by

    subidasagala
    9 views3 pages
    This document is a sworn statement form that public officials and employees must submit declaring their assets, liabilities, net worth, business interests, financial connections, and relatives in government service. The form includes sections for the declarant and spouse's personal details, a list of assets and liabilities, business interests, relatives in government, and a certification that the information provided is true and accurate. It authorizes the Ombudsman to access supporting documentation from government agencies.

    Original Description:

    Statement of Assets, Liabilities and Network

    Original Title

    SALN-2015-Form-1

    Copyright

    © © All Rights Reserved

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    This document is a sworn statement form that public officials and employees must submit declaring their assets, liabilities, net worth, business interests, financial connections, and relatives in government service. The form includes sections for the declarant and spouse's personal details, a list of assets and liabilities, business interests, relatives in government, and a certification that the information provided is true and accurate. It authorizes the Ombudsman to access supporting documentation from government agencies.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    9 views3 pages

    SALN 2015 Form 1

    Uploaded by

    subidasagala
    This document is a sworn statement form that public officials and employees must submit declaring their assets, liabilities, net worth, business interests, financial connections, and relatives in government service. The form includes sections for the declarant and spouse's personal details, a list of assets and liabilities, business interests, relatives in government, and a certification that the information provided is true and accurate. It authorizes the Ombudsman to access supporting documentation from government agencies.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    You are on page 1of 3

    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.
    q Joint Filing q Separate Filing q 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*
    DESCRIPTION KIND EXACT LOCATION ASSESSED CURRENT FAIR ACQUISITION ACQUISITION
    VALUE MARKET VALUE COST
    (e.g. lot, house and (e.g. residential, commercial, (As found in the Tax Declaration of Real YEAR MODE
    lot, condominium and industrial, agricultural and Property)
    improvements) mixed use)

    Subtotal: -
    b. Personal Properties*
    ACQUISITION
    DESCRIPTION YEAR ACQUIRED
    COST/AMOUNT

    Subtotal: -

    TOTAL ASSETS (a+b): -


    * Additional sheet/s may be used, if necessary.
    2. LIABILITIES*
    NATURE NAME OF CREDITORS OUTSTANDING BALANCE

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

    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 INTEREST OR
    ENTERPRISE INTEREST &/OR FINANCIAL 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:

    the above-stated government issued identification card.

    (Person Administering Oath)

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