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 JANUARY 30, 2017
(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: JUANENGO MA. KATRINA NADINE G. POSITION: ATTORNEY I

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: SOCIAL SECURITY SYSTEM
ADDRESS: B7 L24 TOPAZ ST., SOLDIERS HILLS III OFFICE ADDRESS: SSS MAIN BUILDING, EAST
TALA, CALOOCAN CITY AVENUE, DILIMAN, QUEZON CITY

SPOUSE: N/A POSITION:

(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 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*
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
Real Property)
YEAR MODE
use)

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

Subtotal: 0
b. Personal Properties*
DESCRIPTION YEAR ACQUIRED ACQUISITION
COST/AMOUNT

SAMSUNG CELLPHONE A5 (2015) 2015 14,000

FUJITSU LAPTOP 2010 25,000
CASH IN BANK 2015-2016 80,000

Subtotal : 119,000

TOTAL ASSETS (a+b): 119,000

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

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2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

N/A N/A N/A

TOTAL LIABILITIES: 0
NET WORTH : Total Assets less Total Liabilities = 119,000
* 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
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
NIDA G. JUANENGO MOTHER SENIOR SOCIAL SECURITY SYSTEM, SSS MAIN BUILDING,
EXECUTIVE EAST AVE., DILIMAN, QUEZON CITY
ASSISTANT

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: ______________________________

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

Government Issued ID: Government Issued ID:

ID No.: ID No.:
Date Issued: Date Issued:

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

_______________________________________
(Person Administering Oath)

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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 ________________________________
(Sample additional sheet/s for the exclusive properties of the declarant’s spouse and unmarried children
below eighteen (18) years of age living in declarant’s household)

NAME: POSITION:
(Family Name) (First Name) (M.I.) AGENCY/OFFICE:

ASSETS, LIABILITIES AND NET WORTH

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, VALUE
lot, condominium agricultural and
and improvements) mixed use)
(As found in the Tax Declaration of
Real Property)
YEAR MODE

b. Personal Properties
DESCRIPTION YEAR ACQUIRED ACQUISITION
COST/AMOUNT

2. LIABILITIES
NATURE NAME OF CREDITORS OUTSTANDING BALANCE

BUSINESS INTERESTS AND FINANCIAL CONNECTIONS

NAME OF ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF

ENTERPRISE INTEREST &/OR FINANCIAL INTEREST OR CONNECTION
CONNECTION

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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 ________________________________
(Sample additional sheet/s for the declarant)

NAME: POSITION:
(Family Name) (First Name) (M.I.) AGENCY/OFFICE:

ASSETS, LIABILITIES AND NET WORTH

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, VALUE
lot, condominium agricultural and
and improvements) mixed use)
(As found in the Tax Declaration of
Real Property)
YEAR MODE

Subtotal:
b. Personal Properties
DESCRIPTION YEAR ACQUIRED ACQUISITION COST/AMOUNT

Subtotal :
TOTAL ASSETS (a+b):
2. LIABILITIES
NATURE NAME OF CREDITORS OUTSTANDING BALANCE

TOTAL LIABILITIES:

BUSINESS INTERESTS AND FINANCIAL CONNECTIONS

NAME OF ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF

ENTERPRISE INTEREST &/OR FINANCIAL INTEREST OR CONNECTION
CONNECTION

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