Saln Blank Form

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 2023
(Required by R. 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: POVADORA JEZEBEL A. POSITION: ADMINISTRATIVE ASSISTANT II

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPED-CEBU PROVINCE
ADDRESS: OFFICE ADDRESS: IPHO BLDG;SUDLON
LAHUG,CEBU CITY
SPOUSE: POVADORA JENJOE P. 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

AIWAHH A. POVADORA 09/28/2013 10
OHARA A. POVADORA 01/31/2019 5
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,
and improvements) industrial, (As found in the Tax Declaration of YEAR MODE
agricultural and Real Property)
mixed use)
HOUSE & RESIDENTI MANAGASE, BORBON 2010 N/A 300,000.00

LOT AL
LOT AGRICULTUR MANAGASE TABOGON
AL N/A INHERITED 0
LOT COMMERCIAL BINABAG BOGO

2021 DEED OF 420,000.00
SALE
Subtotal: 720,000.00
b. Personal Properties*
DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT
MULTICAB 2018 126,000.00

MOTORCYCLE 2010 65,000.00
HOME APPLIANCES 2014 40,000.00
GADGETS 2015 30,000.00
JEWELRIES 2018 35,000.00
Subtotal : 296,000.00
TOTAL ASSETS (a+b): 1,016,000.00
* Additional sheet/s may be used, if necessary.
Page 1 of _2__
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: 0
NET WORTH : Total Assets less Total Liabilities = 0
* 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
SARI-SARI STORE MANAGASE BORBON OWNER 2013
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
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: PRC ID Government Issued ID: PASSPORT

ID No.: 1509849 ID No.: P84400059A
Date Issued: 12/21/2016 Date Issued: 08/22/2018
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__

Saln Blank Form

Uploaded by

Copyright:

Available Formats

Saln Blank Form

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Saln Blank Form

Uploaded by

Copyright:

Available Formats

Revised as of January 2015

Per CSC Resolution No. 1500088

SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH

DECLARANT: POVADORA JEZEBEL A. POSITION: ADMINISTRATIVE ASSISTANT II

SPOUSE: POVADORA JENJOE P. POSITION: N/A

NAME DATE OF BIRTH AGE

ASSETS, LIABILITIES AND NETWORTH

DESCRIPTION KIND EXACT ASSESSED CURRENT FAIR ACQUISITION ACQUISITION

HOUSE & RESIDENTI MANAGASE, BORBON 2010 N/A 300,000.00

LOT COMMERCIAL BINABAG BOGO

DESCRIPTION YEAR ACQUIRED ACQUISITION

MULTICAB 2018 126,000.00

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

N/A N/A N/A

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

RELATIVES IN THE GOVERNMENT SERVICE

 I/We do not know of any relative/s in the government service)

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

Government Issued ID: PRC ID Government Issued ID: PASSPORT

You might also like