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    Assets and Liabilities Form 1994

    Uploaded by

    Leonil Estaño
    This document is a sworn statement form requiring government employees to disclose their assets, liabilities, net worth, business interests, financial connections, and relatives employed by the government. The form includes sections for the employee's personal information, assets and liabilities, business interests and financial connections, and relatives employed by the government. The employee and their spouse must sign and date the form, certifying that the information provided is true and accurate.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Assets and Liabilities Form 1994

    Uploaded by

    Leonil Estaño
    254 views2 pages
    This document is a sworn statement form requiring government employees to disclose their assets, liabilities, net worth, business interests, financial connections, and relatives employed by the government. The form includes sections for the employee's personal information, assets and liabilities, business interests and financial connections, and relatives employed by the government. The employee and their spouse must sign and date the form, certifying that the information provided is true and accurate.

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    This document is a sworn statement form requiring government employees to disclose their assets, liabilities, net worth, business interests, financial connections, and relatives employed by the government. The form includes sections for the employee's personal information, assets and liabilities, business interests and financial connections, and relatives employed by the government. The employee and their spouse must sign and date the form, certifying that the information provided is true and accurate.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    254 views2 pages

    Assets and Liabilities Form 1994

    Uploaded by

    Leonil Estaño
    This document is a sworn statement form requiring government employees to disclose their assets, liabilities, net worth, business interests, financial connections, and relatives employed by the government. The form includes sections for the employee's personal information, assets and liabilities, business interests and financial connections, and relatives employed by the government. The employee and their spouse must sign and date the form, certifying that the information provided is true and accurate.

    Copyright:

    Attribution Non-Commercial (BY-NC)
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    (Form 1)

    1994
    SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH
    DISCLOSURE OF BUSINESS INTERESTS AND FINANCIAL CONNECTIONS
    AND IDENTIFICATION OF RELATIVES IN THE GOVERNMENT SERVICE
    As of _______________________
    (Required by R.A. 6713)

    Name Position/Income
    (Surname) (First Name) (M.I.) Office
    Address Office Address

    Spouse Name Position


    (Surname) (First Name) (M.I.) Office

    Unmarried Children below 18 years of age


    Name Date of Birth

    A. ASSETS, LIABILITIES AND NETWORTH


    1. ASSETS
    a. Real Properties
    Kind Location Year Mode of Nature of Assessed Current Fair Acquisition Cost
    Acquired Acquisition Property Value Market Value Land; Improve-
    Bldg., etc. ments

    Total: P
    b. Personal and other Properties
    kind Year Acquired Acquisition Cost

    Total: P
    2. LIABILITIES (Loans, Mortgages, etc.)
    Nature Name of Creditors Amount

    Total: P

    NETWORTH (Total Assets (1a + 1b) Less Total Liabilities (2) Total: P

    (Note: Please use additional forms/sheets if necessary.


    Also, please reproduce this form back to back)
    B. BUSINESS INTERESTS AND FINANCIAL CONNECTIONS

    Do you have any business interests and other financial connections including those of your spouse and
    unmarried children below 18 years of age living with you in your household?
    Yes No If yes, give particulars:

    Name Name of Firm/ Address Nature of Business Date of Acquisition


    Company Interest and/or or Connection
    Financial Connection

    C. IDENTIFICATION OF RELATIVES IN THE GOVERNMENT SERVICE

    To the best of your knowledge, are you related within the fourth degree of consanguinity or of affinity to
    anyone working in the government?
    Yes No If yes, give particulars:

    Name Position Relationship Name/Address of Office

    I hereby certify to the best of my knowledge and information, that these are true statements of my
    assets, liabilities, networth, business interests and financial connections, including those of my spouse and
    unmarried children below 18 years of age and names of my relatives in the government as of ____________,
    ______, as required by and in accordance with Republic Act 6713.

    I hereby authorize the Ombudsman or his 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, networth, 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 Spouse) (Signature of Employee)

    TIN : TIN :

    Com. Cert. No. Com. Cert. No.


    Issued at : Issued at :
    Date Issue : Date Issue :

    SUBSCRIBED AND SWORN to before me this _____ day of ___________________, affiant exhibiting his/her

    RESIDENCE TAX CERTIFICATE as indicated above.

    (Person Administering Oath)

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