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    Roselyn Saln

    Uploaded by

    JB Dantes

    Copyright:

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

    Roselyn Saln

    Uploaded by

    JB Dantes
    1 views3 pages

    Copyright

    © © All Rights Reserved

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    DOC, PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    1 views3 pages

    Roselyn Saln

    Uploaded by

    JB Dantes

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 3

    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 NOVEMBER 20, 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 BALADAD ROSELYN O. POSITION: SK MEMBER


    :
    (Family Name) (First Name) (M.I.) AGENCY/OFFICE: BLGU-JACINTO
    ADDRESS: OFFICE ADDRESS: BRGY, JACINTO, CALBAYOG CITY,
    BRGY. JACINTO CALBAYOG CITY SAMAR SAMAR

    SPOUSE: N/A N/A N/A POSITION: 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 N/A N/A
    N/A N/A N/A
    N/A N/A N/A
    N/A N/A 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*

    DESCRIPTIO KIND EXACT ASSESSED CURRENT FAIR ACQUISITION ACQUISITION


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

    N/A N/A N/A N/A N/A N/A N/A N/A


    N/A N/A N/A N/A N/A N/A N/A N/A
    N/A N/A N/A N/A N/A N/A N/A N/A
    N/A N/A N/A N/A N/A N/A N/A N/A
    Subtotal:
    b. Personal Properties*

    DESCRIPTION YEAR ACQUIRED ACQUISITION


    COST/AMOUNT

    1 UNIT OF ANDROID PHONE 2023 5000


    N/A N/A N/A
    N/A N/A N/A
    N/A N/A N/A
    Subtotal: 5000

    TOTAL ASSETS (a+b): 5000


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

    Page 1 of 2
    2. LIABILITIES*

    NATURE NAME OF CREDITORS OUTSTANDING


    BALANCE

    N/A N/A N/A


    N/A N/A N/A
    N/A N/A N/A
    N/A N/A N/A
    TOTAL LIABILITIES:
    NET WORTH : Total Assets less Total Liabilities =
    * 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 CONNECTION
    ENTERPRISE CONNECTION
    N/A N/A N/A N/A
    N/A N/A N/A N/A
    N/A N/A N/A N/A
    N/A N/A N/A N/A

    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
    N/A N/A N/A N/A
    N/A N/A N/A N/A
    N/A N/A N/A N/A
    N/A N/A N/A N/A
    N/A N/A N/A N/A

    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: NOVEMBER 20, 2023

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

    Government Issued ID: Government Issued ID: N/A


    ID No.: ID No.: N/A
    Date Issued: Date Issued: N/A

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

    _______________________________________
    Page 2 of 2
    (Person Administering Oath)

    Page 3 of 2

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