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2015 Saln Form

This document is a sworn statement of assets, liabilities, and net worth as of December 31, 2021 submitted by Fidel Arlene N. Positions as a Corrections Officer 1. It lists their assets including consumer goods worth ₱150,000, watches and jewelry worth ₱100,000, and clothing worth ₱250,000 for a total of ₱580,000. Liabilities include various loans totaling ₱211,767.97, resulting in a net worth of ₱368,232.03. It also discloses relatives in government service.

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28 views3 pages

2015 Saln Form

This document is a sworn statement of assets, liabilities, and net worth as of December 31, 2021 submitted by Fidel Arlene N. Positions as a Corrections Officer 1. It lists their assets including consumer goods worth ₱150,000, watches and jewelry worth ₱100,000, and clothing worth ₱250,000 for a total of ₱580,000. Liabilities include various loans totaling ₱211,767.97, resulting in a net worth of ₱368,232.03. It also discloses relatives in government service.

Uploaded by

jasper
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
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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, 2021
(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: FIDEL ARLENE N. POSITION: CORRECTIONS OFFICER 1


(Family Name) (First Name) (M.I.) AGENCY/OFFICE: BUREAU OF CORRECTIONS
ADDRESS: BLK. 2 ARMOR VILLAGE, SAN JOSE GUSU OFFICE ADDRESS: SAN RAMON, ZAMBOANGA CITY
ZAMBOANGA CITY

SPOUSE: FIDEL RYAN JAY E (DECEASED) 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


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)

N/A

Subtotal:
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION


COST/AMOUNT

COMSUMER WELFARE PRODUCTS AND APPLIANCES 2005-2021 ₱ 150,000.00


WATCHES AND JEWELRIES 2005-2021 ₱ 100,000.00
CLOTHINGS, BAGS AND OTHERS 2005-2021 ₱ 250,000.00
COB 2021 ₱ 80,000.00
Subtotal : ₱ 580,000.00

TOTAL ASSETS (a+b):


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

Page 1 of ___
2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

CONSOLIDATED LOAN GSIS ₱ 56,756.98


CALAMITY LOAN GSIS ₱ 30, 010.99
POLICY LOAN GSIS ₱ 11,000.00
SALARY LOAN DBP ₱ 114,000.00
TOTAL LIABILITIES: ₱ 211,767.97
NET WORTH : Total Assets less Total Liabilities = ₱ 368,232.03
* 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

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
ANABEL A. NOGUERA-ENDOZO SISTER TEACHER II DEPED/ BALIWASAN SENIOR HIGH SCHOOOL
ROSE G. ASTRERO COUSIN FO II BUREAU OF FIRE
CIELY N. ORGANISTA COUSIN TEACHER II DEPARTMENT OF EDUCATION
MONET LORRAINE F. LUNA SIS-IN-LAW ENGINEER CITY ENGINEERS OFFICE/ ZAMBOANGA CITY

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: FEBRUARY 02, 2022

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

Government Issued ID: BUCOR I.D Government Issued ID:


ID No.: 1499-0313 ID No.:
Date Issued: 05/02/2021 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 ___
(Person Administering Oath)

Page 3 of ___

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