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    Sworn Statement of Assets, Liabilities and Net Worth: Saln Revised 2013 As of

    Uploaded by

    Catherine Librado Encabo
    This document is a form for public officials in the Philippines to disclose their assets, liabilities, net worth, business interests, and financial connections as well as those of their spouse and unmarried children under 18 living in their household. It also requires the disclosure of any relatives within the 4th degree of consanguinity or affinity working in the government. The declarant must sign and be sworn before a notary.

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

    Sworn Statement of Assets, Liabilities and Net Worth: Saln Revised 2013 As of

    Uploaded by

    Catherine Librado Encabo
    27 views3 pages
    This document is a form for public officials in the Philippines to disclose their assets, liabilities, net worth, business interests, and financial connections as well as those of their spouse and unmarried children under 18 living in their household. It also requires the disclosure of any relatives within the 4th degree of consanguinity or affinity working in the government. The declarant must sign and be sworn before a notary.

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    SALN

    Original Title

    Saln Blank

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    This document is a form for public officials in the Philippines to disclose their assets, liabilities, net worth, business interests, and financial connections as well as those of their spouse and unmarried children under 18 living in their household. It also requires the disclosure of any relatives within the 4th degree of consanguinity or affinity working in the government. The declarant must sign and be sworn before a notary.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    27 views3 pages

    Sworn Statement of Assets, Liabilities and Net Worth: Saln Revised 2013 As of

    Uploaded by

    Catherine Librado Encabo
    This document is a form for public officials in the Philippines to disclose their assets, liabilities, net worth, business interests, and financial connections as well as those of their spouse and unmarried children under 18 living in their household. It also requires the disclosure of any relatives within the 4th degree of consanguinity or affinity working in the government. The declarant must sign and be sworn before a notary.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    SALN

    Revised 2013

    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.

    Joint Filing

    Separate Filing

    DECLARANT

    Not Applicable

    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 DECLARANTS 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 declarants household)
    1. ASSETS
    a.

    Real Properties*

    DESCRIPTION

    KIND

    (e.g. lot, house and


    lot, condominium
    and improvements)

    (e.g. residential,
    commercial, industrial,
    agricultural and mixed
    use)

    LOCATION

    ASSESSED

    CURRENT FAIR

    VALUE

    MARKET VALUE

    (As found in the Tax Declaration of


    Real Property)

    ACQUISITION
    YEAR

    ACQUISITION COST

    MODE

    Subtotal:

    b. Personal Properties*
    DESCRIPTION

    YEAR ACQUIRED

    ACQUISITION COST/AMOUNT

    Subtotal :
    TOTAL ASSETS (a+b):
    2. LIABILITIES*
    NATURE

    NAME OF CREDITORS

    Page __ of ___

    OUTSTANDING BALANCE

    TOTAL LIABILITIES:
    NET WORTH : Total Assets less Total Liabilities =
    * Additional sheet/s may be used, if necessary.
    SALN
    Revised 2013
    BUSINESS INTERESTS AND FINANCIAL CONNECTIONS
    (of Declarant /Declarants spouse/ Unmarried Children Below Eighteen (18) years of Age Living in Declarants Household)

    I/We do not have any business interest or financial connection.


    NAME OF
    ENTITY/BUSINESS
    ENTERPRISE

    BUSINESS ADDRESS

    NATURE OF BUSINESS
    INTEREST &/OR FINANCIAL
    CONNECTION

    DATE OF ACQUISITION OF
    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, 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 aboveenumerated 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:


    ID No.:
    Date Issued:

    Government Issued ID:


    ID No.:
    Date Issued:

    SUBSCRIBED AND SWORN to before me this


    government issued identification card.

    day of

    Page __ of ___

    , affiant exhibiting to me the above-stated

    _______________________________________
    (Person Administering Oath)

    Page __ of ___

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