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Form SALN

This document is a sworn statement of assets, liabilities, and net worth that must be filed by public officials and employees in the Philippines. It requires the declarant to disclose their personal details and financial information including real property, personal property, liabilities, business interests, relatives in government, and contains spaces for signatures to declare the truth of the information provided.

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Karl Badoles
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37 views2 pages

Form SALN

This document is a sworn statement of assets, liabilities, and net worth that must be filed by public officials and employees in the Philippines. It requires the declarant to disclose their personal details and financial information including real property, personal property, liabilities, business interests, relatives in government, and contains spaces for signatures to declare the truth of the information provided.

Uploaded by

Karl Badoles
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, 2023
(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: DOGELIO MICHAEL S. POSITION: TEACHER I


(Family Name) (First Name) (M.I.) AGENCY/OFFICE: VICENTE ANDAYA SR. NHS
ADDRESS: ROSEVILLE HEIGHTS, ROXAS CITY , CAPIZ OFFICE ADDRESS: POB.SUR, SIGMA, CAPIZ

SPOUSE: NA 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 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)

Subtotal:
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION


COST/AMOUNT

LAPTOP 2023 52,000


REGRIGERATOR 2023 25,000
PRINTER 2023 9,000
INSURANCE 2023 38,400
Subtotal : 124,400

TOTAL ASSETS (a+b): 124,400


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

Page 1 of ___
2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

SALARY LOAN CITY SAVINGS BANK 300,000

TOTAL LIABILITIES: 300,000


NET WORTH : Total Assets less Total Liabilities = -175,000
* 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

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 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 Government Issued ID:


ID No.: 1786637 ID No.:
Date Issued: 06/26/2019 Date Issued:

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 ___

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