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Sworn Statement of Assets, Liabilities and Net Worth

The document is a sworn statement of assets, liabilities and net worth for a public official. It details the official's personal information, assets like property and vehicles, liabilities like loans, relatives in government, and authorizes the Ombudsman to access financial records. The official declares their assets, liabilities and net worth as required by law.

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CHEENY TAMAYO
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31 views3 pages

Sworn Statement of Assets, Liabilities and Net Worth

The document is a sworn statement of assets, liabilities and net worth for a public official. It details the official's personal information, assets like property and vehicles, liabilities like loans, relatives in government, and authorizes the Ombudsman to access financial records. The official declares their assets, liabilities and net worth as required by law.

Uploaded by

CHEENY TAMAYO
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
You are on page 1/ 3

Revised as of January 2015

Per CSC Resolution No. 1500088


Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH


December 31,
As of _____________ 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: TAMAYO CHEENY O. POSITION: TEACHER 1


(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DepEd /PUTI-AN NATIONAL HIGH
SCHOOL
ADDRESS: PUTI-AN, CUARTERO, CAPIZ OFFICE ADDRESS: PUTI-AN CUARTERO CAPIZ

SPOUSE: N/A POSITION: N/A


(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
N/A N/A N/A

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)

PUTI-AN, CUARTERO,
HOUSE RESIDENTIAL ₱100,000 ₱100,000.00 2019 BUILT ₱100,000.00
CAPIZ

Subtotal: P 100,000.00
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION


COST/AMOUNT

GADGETS 2018 ₱ 15,000.00


APPLIANCES 2019 ₱35,000.00
JEWELRIES 2018 ₱30,000.00
MOTORCYCLE 2018 ₱60,000.00
Subtotal : ₱ 140,000.00

TOTAL ASSETS (a+b): ₱ 240,000.00


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

Page 1 of 2
2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

SALARY LOAN EASTWEST RURAL BANK ₱63,099.00


SALARY LOAN CHINA BANK SAVINGS ₱79, 736.00

TOTAL LIABILITIES: ₱142,835.00


NET WORTH : Total Assets less Total Liabilities = ₱ 97,165.00
* 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 .

NAME OF ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF


ENTERPRISE INTEREST &/OR FINANCIAL INTEREST OR CONNECTION
CONNECTION
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
HENLY O. LLAMAS AUNT TEACHER III DEPED-PUTI AN ELEMENTARY SCHOOL

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: MARCH 04, 2021 ____________________________________

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

Government Issued ID: PRC Government Issued ID:


ID No.: 1354984 ID No.:
Date Issued: JANUARY 13, 2015 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 2
(Person Administering Oath)

Page 3 of 2

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