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    Sworn Statement of Assets, Liabilities and Net Worth: Joint Filing Separate Filing

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    PatzAlzateParaguya
    This document contains a sworn statement of assets, liabilities and net worth for an individual. It lists the individual's personal details and position. It then provides an inventory of the individual's assets and liabilities, including real estate, personal property, loans and resulting net worth. It also discloses any business interests or relatives in government.

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    Sworn Statement of Assets, Liabilities and Net Worth: Joint Filing Separate Filing

    Uploaded by

    PatzAlzateParaguya
    13 views2 pages
    This document contains a sworn statement of assets, liabilities and net worth for an individual. It lists the individual's personal details and position. It then provides an inventory of the individual's assets and liabilities, including real estate, personal property, loans and resulting net worth. It also discloses any business interests or relatives in government.

    Original Title

    SAL-N_FATE_2020_1

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    This document contains a sworn statement of assets, liabilities and net worth for an individual. It lists the individual's personal details and position. It then provides an inventory of the individual's assets and liabilities, including real estate, personal property, loans and resulting net worth. It also discloses any business interests or relatives in government.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    13 views2 pages

    Sworn Statement of Assets, Liabilities and Net Worth: Joint Filing Separate Filing

    Uploaded by

    PatzAlzateParaguya
    This document contains a sworn statement of assets, liabilities and net worth for an individual. It lists the individual's personal details and position. It then provides an inventory of the individual's assets and liabilities, including real estate, personal property, loans and resulting net worth. It also discloses any business interests or relatives in government.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    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

    FORROSUELO , FATE P.
    DECLARANT POSITION: TEACHER- II
    :
    (Family Name) (First Name) (M.I.) AGENCY/OFFICE: LA PURISIMA, CAGWAIT, SDS.
    ADDRESS: OFFICE ADDRESS:
    P-TALISAY-A, ARAS-ASAN, CAGWAIT, SURIGAO
    DEL SUR

    SPOUSE: POSITION: N/A


    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*

    DESCRIPTI KIND LOCATION ASSESSED CURRENT FAIR ACQUISITION ACQUISITION COST


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

    NONE

    b. Personal Properties*

    DESCRIPTION YEAR ACQUIRED ACQUISITION COST/AMOUNT

    CLOTHINGS & SHOES 2019 5,000.00


    LAPTOP 2019 35,000
    MOTORCYCLE 2020 102,000
    CELL PHONE 2021 13,000

    Subtotal : 155,000.00
    TOTAL ASSETS (a+b): 155,000.00

    Page 1 of 2
    2. LIABILITIES*

    NATURE NAME OF CREDITORS OUTSTANDING BALANCE

    SALARY LOAN ENTERPRISE BANK 89,000


    SALARY LOAN SOCIAL SECURITY SYSTEM 5,170

    TOTAL LIABILITIES: 94,170

    NET WORTH : Total Assets less Total Liabilities = 60,830.00


    * 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 BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF
    ENTITY/BUSINESS INTEREST &/OR FINANCIAL INTEREST OR
    ENTERPRISE CONNECTION CONNECTION
    NOT APPLICABLE

    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
    NONE

    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:

    FATE P. FORROSUELO N/A


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

    Government Issued ID: PRC

    ID No.: 1471377
    Date Issued: 7/12/2016

    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 2

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