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    Sworn Statement of Assets, Liabilities and Net Worth: Joint Filing Separate Filing Not Applicable

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    Edwino Nudo Barbosa Jr.
    1) This is a sworn statement of assets, liabilities, and net worth form required by Philippine law to be filed by public officials and employees. 2) It requires the disclosure of real and personal assets and properties, liabilities, business interests, financial connections, and relatives in government. 3) The declarant and their spouse authorize the Ombudsman to obtain documents from government agencies like the Bureau of Internal Revenue regarding their assets, liabilities, and financial records for previous years.

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    Sworn Statement of Assets, Liabilities and Net Worth: Joint Filing Separate Filing Not Applicable

    Uploaded by

    Edwino Nudo Barbosa Jr.
    25 views5 pages
    1) This is a sworn statement of assets, liabilities, and net worth form required by Philippine law to be filed by public officials and employees. 2) It requires the disclosure of real and personal assets and properties, liabilities, business interests, financial connections, and relatives in government. 3) The declarant and their spouse authorize the Ombudsman to obtain documents from government agencies like the Bureau of Internal Revenue regarding their assets, liabilities, and financial records for previous years.

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    SALN-2020_

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    1) This is a sworn statement of assets, liabilities, and net worth form required by Philippine law to be filed by public officials and employees. 2) It requires the disclosure of real and personal assets and properties, liabilities, business interests, financial connections, and relatives in government. 3) The declarant and their spouse authorize the Ombudsman to obtain documents from government agencies like the Bureau of Internal Revenue regarding their assets, liabilities, and financial records for previous years.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    25 views5 pages

    Sworn Statement of Assets, Liabilities and Net Worth: Joint Filing Separate Filing Not Applicable

    Uploaded by

    Edwino Nudo Barbosa Jr.
    1) This is a sworn statement of assets, liabilities, and net worth form required by Philippine law to be filed by public officials and employees. 2) It requires the disclosure of real and personal assets and properties, liabilities, business interests, financial connections, and relatives in government. 3) The declarant and their spouse authorize the Ombudsman to obtain documents from government agencies like the Bureau of Internal Revenue regarding their assets, liabilities, and financial records for previous years.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
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    You are on page 1of 5

    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, 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: ss 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 ASSESSED CURRENT FAIR


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

    Subtotal: 0.00
    b. Personal Properties*
    ACQUISITION
    DESCRIPTION YEAR ACQUIRED
    COST/AMOUNT
    Subtotal: 0.00

    TOTAL ASSETS (a+b): 0.00

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

    Page 1 of 2
    2. LIABILITIES*

    NATURE NAME OF CREDITORS OUTSTANDING BALANCE

    TOTAL LIABILITIES: 0.00


    NET WORTH: Total Assets less Total Liabilities = 0.00
    * 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.

    NATURE OF BUSINESS
    NAME OF ENTITY/BUSINESS DATE OF ACQUISITION OF
    BUSINESS ADDRESS INTEREST & / OR FINANCIAL
    ENTERPRISE INTEREST OR CONNECTION
    CONNECTION

    RELATIVE/S IN THE GOVERNMENT


    (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 _____________________________ , affiant exhibiting to me the above-
    stated government issued identification card.

    TEODORO A. GLORIANI EdD


    (Person Administering Oath)

    Page 2 of 2

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