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Sworn Statement of Assets, Liabilities and Net Worth

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Jesusima Bayeta Albia
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30 views

Sworn Statement of Assets, Liabilities and Net Worth

Uploaded by

Jesusima Bayeta Albia
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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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, 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

DECLARANT: ALBIA JESUSIMA B. POSITION: TEACHER II


(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DepED NCR DIVISION OF PASIG
CITY
ADDRESS: BLDG. E UNIT 209, SORRENTO OASIS OFFICE ADDRESS: CANIOGAN ELEMENTARY
SCHOOL
KALINANGAN ST., CANIOGAN,
BRGY. ROSARIO, PASIG CITY PASIG CITY

SPOUSE: ALBIA HIPOLITO R. POSITION: JUNIOR ACCOUNTING MANAGER


(Family Name) (First Name) (M.I.) AGENCY/OFFICE: CHEF'S SECRET INC.
OFFICE ADDRESS: 102 F. PASCO AVENUE .BRGY.
SANTOLAN
PASIG CITY

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S HOUSEHOLD
NAME DATE OF BIRTH AGE
NONE NONE NONE
NONE NONE NONE
NONE NONE NONE
NONE NONE NONE

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

BLDG.E UNIT 209 SORRENTO


CONDOMINIUM RESIDENTIAL OASIS BRGY.ROSARIO PASIG 2,734,300.00 2016 NSTALLMENT
2,734,300.00
CITY

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: ₱2,734,300.00
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION


COST/AMOUNT

GADGETS/APPLIANCES VARIOUS YEARS 228,500.00


CASH ON HAND/ IN THE BANKS VARIOUS YEARS 121,500.00
APPAREL VARIOUS YEARS 54,200.00
TRICYCLE (BARAKO MOTORCYCLE) 2013 117,000.00
MOTOR (FURY) 2015 96,000.00
Subtotal : ₱617,200.00

TOTAL ASSETS (a+b): ₱3,351,500.00

Page 1 of ___
2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

SALARY LOAN EAST WEST BANK 55,991.16


REAL PROPERTY LOAN(FOR CONDO UNIT) UCPB 3,385,152.00
N/A N/A N/A
N/A N/A N/A
TOTAL LIABILITIES: ₱3,441,143.16
NET WORTH : Total Assets less Total Liabilities = -₱89,643.16
* 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
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: __January 17, 2020_________________

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

Government Issued ID: PROFESSIONAL IDENTIFICATION CARD Government Issued ID: PROFESSIONAL IDENTIFICATION CARD
ID No.: 1004575 ID No.: 177828
Date Issued: NOVEMBER 15, 2017 Date Issued: DECEMBER 6, 2017

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

BENJAMIN C. JACOSALEM
Administrative Officer V
_______________________________________
(Person Administering Oath)

Page 2 of ___

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