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    Sworn Statement of Assets, Liabilities and Net Worth: Joint Filing Separate Filing Not Applicable

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    shane jandoc
    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 certification that the information is true.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    Sworn Statement of Assets, Liabilities and Net Worth: Joint Filing Separate Filing Not Applicable

    Uploaded by

    shane jandoc
    13 views2 pages
    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 certification that the information is true.

    Original Title

    2015 Saln Form

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    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 certification that the information is true.

    Copyright:

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

    Sworn Statement of Assets, Liabilities and Net Worth: Joint Filing Separate Filing Not Applicable

    Uploaded by

    shane jandoc
    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 certification that the information is true.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    You are on page 1of 2

    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: JANDOC HONEY SHANE T. POSITION: TEACHER I


    (Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPED-SARANGANI
    ADDRESS: PUROK CASPOT, PANGYAN, GLAN, OFFICE ADDRESS: CAPITOL COMPOUND, ALABEL,
    SARANGANI PROVINCE SARANGANI PROVINCE

    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

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

    NONE

    NONE

    NONE

    NONE

    Subtotal:
    b. Personal Properties*

    DESCRIPTION YEAR ACQUIRED ACQUISITION


    COST/AMOUNT
    MOTORCYLE 2019 100,000
    APPLIANCES 2020 50,000
    CLOTHING 2021 30,000
    JEWELRIES 2021 20,000
    Subtotal : 200,000

    TOTAL ASSETS (a+b): 200,000


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

    Page 1 of _2_
    2. LIABILITIES*

    NATURE NAME OF CREDITORS OUTSTANDING BALANCE

    SALARY LOAN CITY SAVINGS 145,000


    SALARY LOAN BDO 43,000

    TOTAL LIABILITIES: 188,000


    NET WORTH : Total Assets less Total Liabilities = 12,000
    * 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
    NONE

    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
    MELANIE B. BAGALANGIT COUSIN TEACHER III DEPED SARANGANI

    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: January 20, 2022

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

    Government Issued PRC Government Issued NONE


    ID: ID:
    ID No.: 1725315 ID No.:
    Date Issued: 01/15/2019 Date Issued:

    SUBSCRIBED AND SWORN to before me this __ day of , affiant exhibiting to me the above-stated government issued
    identification card.

    IRMA MAY G. DINASAS, AO V


    (Person Administering Oath)

    Page 2 of _2_

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