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, 2022
(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: MANCAO MYLENE C. POSITION: TEACHER III
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: Department of Education
OFFICE ADDRESS: Landan National High School
ADDRESS: Purok Paraiso Brgy. Cannery Site Brgy. Landan, Polomolok, South Cotabato
Polomolok, South Cotabato

SPOUSE: MANCAO PORFERIO JR. V. POSITION: Self-employed/Driver

(Family Name ) (First Name) (M.I.) AGENCY/OFFICE: Crisjun Bakeshoppe
OFFICE ADDRESS: Immaculate Village Valencia Site
Polomolok, South Cotabato

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT'S HOUSEHOLD
NAME DATE OF BIRTH AGE
LANCE GIAN ANDREI C. MANCAO 11/20/2004 18
CEDRICK JAMES C. MANCAO 4/22/2006 16

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*

ASSESSED CURRENT FAIR

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

Purok Paraiso, Brgy.

House & Lot Residential Cannery Site PSC 2017 Cash 300,000.00
N/A N/A

Subtotal: 300,000.00

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION COST/AMOUNT

St. Peter Plan 2019 39,000.00

Honda XRM Motorcyle 2014 45,000.00
Appliances & Furniture 2014-2022 235,000.00
Jewelries & Clothing 2013-2022 265,000.00
Subtotal: 584,000.00
TOTAL ASSETS (a+b): 884,000.00

2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

Salary Loan GSIS Multi Purpose Loan 235,500.00

Salary Loan City Savings Bank 196,650.00
Salary Loan Loan Express 90,000.00
Motorcycle Loan CDO Cycle Mart 160,000.00
TOTAL LIABILITIES: 682,150.00
* Additional sheet/s may be used, if necessary. NET WORTH: Total Assets less Total Liabilities = 201,850.00

Page 2 of 2
 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 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

MARIVIC M. ZOZOBRADO COUSIN TEACHER DEPED-LAPU-LAPU CITY, CEBU

MARY GRACE M. CHAVEZ COUSIN CONTRACTUAL MUNICIPALITY OF POLOMOLOK

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: February 10, 2023

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

Government Issued ID: GSIS UMID CARD Government Issued ID: TIN ID
ID No: 5157833385 ID No.: 922-043-572
Date Issued: 28-May-19 Date Issued: 7-Feb-01

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

(Person Administering Oath)

Page 2 of 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, 2020
(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 NETWORTH

1. ASSETS
a. Real Properties
ASSESSED CURRENT FAIR
DESCRIPTION KIND ACQUISITION
VALUE MARKET VALUE
(e.g., residential,
EXACT ACQUISITION COST
(e.g. lot, house and lot,
commercial, industrial, LOCATION (As found in the Tax Declaration of Real
condominium, and
agricultural and mixed Property) YEAR MODE
improvements)
used)

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 INTEREST & DATE OF ACQUISITION OF
ENTERPRISE / OR FINANCIAL CONNECTION INTEREST OR CONNECTION
 Page _____ of ______

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 NETWORTH

1. ASSETS

a. Real Properties
DESCRIPTION KIND ASSESSED CURRENT FAIR ACQUISITION
VALUE MARKET VALUE
EXACT
(e.g., residential, ACQUISITION COST
(e.g. lot, house and lot, commercial, industrial, LOCATION (As found in the Tax Declaration of Real
condominium, and agricultural and mixed Property) YEAR MODE
improvements) used)

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 INTEREST & DATE OF ACQUISITION OF
ENTERPRISE / OR FINANCIAL CONNECTION INTEREST OR CONNECTION

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