ࡱ> =< \p Administrator Ba==hK+8X@"1Arial1Arial1Arial1Arial1Arial1Arial1Arial1Arial"$"#,##0_);\("$"#,##0\)!"$"#,##0_);[Red]\("$"#,##0\)""$"#,##0.00_);\("$"#,##0.00\)'""$"#,##0.00_);[Red]\("$"#,##0.00\)7*2_("$"* #,##0_);_("$"* \(#,##0\);_("$"* "-"_);_(@_).))_(* #,##0_);_(* \(#,##0\);_(* "-"_);_(@_)?,:_("$"* #,##0.00_);_("$"* \(#,##0.00\);_("$"* "-"??_);_(@_)6+1_(* #,##0.00_);_(* \(#,##0.00\);_(* "-"??_);_(@_)                + ) , *     D@ @  @@  D@ "0D@ @ "0D@  @ @  @ "8D@ @ "0D@ @ ! "    @  (D@ @  @ "0@ @ "8@@ "0@ "0@@   (  ( " " !  @ @ "0@@ "0@ @  @@ "0@ "p  @ "0@ "0@ "0@ "0  @ "0@ "0@ "0 `.PAGE 1c=PAGE 2RFPAGE 3PPAGE 4`i 5SWORN STATEMENT OF ASSETS, LIABILITIES, AND NET WORTH9DISCLOSURE OF BUSINESS INTEREST AND FINANCIAL CONNECTIONS9AND IDENTIFICATION OF RELATIVES IN THE GOVERNMENT SERVICEAs of December 31, 200___(Required by R.A. No.6713)YName ______________________________________Position/Income_______________________________SurnameZAddress_____________________________________Office Address________________________________YSpouse Name________________________________Position______________________________________> Surname First Name M.I.(Unmarried Children below 18 years of ageName$____________________________________ASSETSa. Real Properties:KINDLOCATIONYEARACQUIREDMODE OF ACQUISITIONASSESSEDVALUE CURRENT FAIR MARKET VALUE!b. Personal and other Properties: YEAR ACQUIREDACQUISITION COSTCOSTLAND BUILDING ETC.IMPROV-MENTS Date of Birth'e. Liabilities (Loans, Mortgages, etc.)NATUREAMOUNT <NET WORTH (Total Assets (La + Lb) Less Total Liabilities (2)HNOTE: Instructions at the Back please use additional forms if necessary)) ________________________________5Position ____________________________________________6Office Address _______________________________________6Position/Income ______________________________________ ______________________ M.I.: Office _______________________________________ First Name$A. ASSETS, LIABILITIES AND NET WORTH^______________________________________________________________________________________________; Office _______________________________________\ Total P________________Total P _______________ 1 Total P________________Y INSTRUCTIONSWHO SHALL FILEhAll public officials and employees, except those who serve in an honorary capacity, laborers and casual uor temporary workers, shall file in three (3) copies under oath the statements of Assets, Liabilities and Net Worth, lDisclosure of Business Interests and Finacial Connections including those of their households, and unmarriedtchildren under eighteen (18) years of age living in their households, and Disclosure of Relatives in the Government.lMarried couples who are public officials or employees may file the required statement jointly or separately. WHEN TO FILER1. Within thirty (30) days after assumption of office, statements of which must be, reckoned as of his first day of service.W2. On or before April 30 of every year thereafter, statements or which must be reckoned+ as of the end of the preceding year; orU3. Within thirty (30) days after separation from the service, statement of which must- be reckoned as of his last day of office.WHEREOFFICE/EMPLOYEEOFFICE WHERE TO FILE5President, Vice President and members of ConstitutionNationa Office of the OmbudsmanCommissions and officesSenatorsSecretary of the Senate Congressman!Secretary General of the House of Representatives3Justices of the Supreme Court and Court of Appeals, Sandiganbayan#Clerk of Court of the Supreme Court7Judges-Regional Trial Court, Metropolitan Circuit TrialCourt Administrator.Court, City Court, Municipal and Special Court3National Executive officials such as Members of theOffice of the President3Cabinet, Undersecretaries and assistant SecretariesRepublic of the Philippines6including the foreign service and heads of government-9owned or controlled corporations with original characters:and their subsidiaries and state colleges and universities:Regional and local officials and employees both appointiveDeputy Ombudsman in their8and elective, including other officials and employees ofrespective regions5government-owned or controlled corporations and their0subsidiaries and state colleges and universities8Officers of the Armed Forces from the rank of colonel orOffice of the President, Naval Captain3Officers of the Armed Forces with ranks below thesementioned above<All other public officials and employees not mentioned aboveCivil Service Commission.B. BUSINESS INTEREST AND FINANCIAL CONNECTIONSpTo have any business ether financial connections including those of your spouse and unmarried children below 18 6years of age living with you in your household/Yes/No/if yes give partiulars; Name of FirmNature of BusinessDate of Acquisition orCompanyAddressinterest and/or ConnectionFincial Connection8C. IDENTIFICATION OF RELATIVES IN THE GOVERNMENT SERVICEtTo the best of your knowledge, are related within the fourth degree of Consanguinity or of afinity or anyone working:in the government?/ / Yes / / No if yes, give particulars;Position RelationshipName/Address of OfficeiI hereby certify to the best of my knowledge and information, that those are true statement of my assets,sliabilities, net worth, business and financial connection those of spouse and unmarried children below 18 years of nage and names of my relatives in the government as of December 31, 200__ as required by and in accordance withRepublic Act 6713.fI hereby authorized the Ombudsman or his dult authorized representative to obtain and secure from all jappropriate government agencies, including the Bureau of Internal Revenue, such documents that may show myoassets, liabilities, net worth, business interests and financial connections, to include those of my spouse andsunmarried 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 __________________200________________________ Signature&Res. Cert. No. _______________________$T.I.N ______________________)Issued at _______________________B:'Date Issued _______________________ ZSUBSCRIBED AND SWORN TO before me this ______day of ____________200____ affiant exhibiting4his Residence Tax Identification as indicated above.Person Administering OathDEFINITION OF TERMSsReal Properties- - - - - - - - - - - - - - - - - - - refer to lands (residentials, commercial, agricultural, etc.){ house and building (apartment, townhouse, etc.) together with improvements.pImprovement- - - - - - - - - - - - - - - - - - - - - connotes valuable additions of betterment or real property( which enchances its value.mAssessed Value- - - - - - - - - - - - - - - - - - - -the appraisal on assessment of real property made by the5 city, Provincial or municipal assessor.qCurrent Fair Market Value- - - - - - - - - - - - -means its actual value, that is, the fair value of the propertyE as between one who wants to purchase and, one who wants to sell it.nPersonal Properties- - - - - - - - - - - - - - - - -properties for personal use such as cash is banks, cash onM hand, jewelry, appliances, furnitures and fixtures, book, cars,) stocks, bonds and the like.\Kind- - - - - - - - - - - - - - - - - - - - - - - - - - - brief description of the property1 real property farmland, residential personal property ]Mode of Acquisition- - - - - - - - - - - - - - - - -Manner by which the property is acquired,3 inheritance, donation, purchase, etc..mCreditor- - - - - - - - - - - - - - - - - - - - - - - - - person, group of persons or company to whom one is B indebted or whom payment is due e.g. GSIS for loans,* Phil-Am for insurance, rent.pNature of Business- - - - - - - - - - - - - - - - - refers to business interest whether as proprietor, investor,F owner, partner, shareholder, officer, managing director,V <' H executive creditor, lawyer, legal consultants or advisers,E financial or business consultant, auditor and the like.hRelatives in the fourth degree- - - - - - - - - -consanguinity and affinity - refer to spouse, parents, y bothers and sisters and their spouse, nephews and nices{ and their spouses, bilas, inso, balae, step parents, halfm brothers and half sisters and their spouse.| consanguinity and afinity - refer to spouse, parents, brother    + [w   #?6R*@!\"$ L'h);1,)cc  <0$7<  dMbP?_*+%&?'?(?)@MHP DeskJet 600 (Color)@n,,@山D$HP DeskJet 600 (Color)d"d,,??U} m}  } I } $ } } }  } <     -------- -------- -------- -------- --------  *  . , -  ) 0  (  1    !   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