HRep SALN Form (2019)

Per House Resolution No. 176

(Adopted from the 2015 CSC SALN Form)

SWORNSTATEMENT OF ASSETS, LIABILITIES AND NET WORTH (SALN)

As of 31 December 2023
(Required by R.A. 6713 and House Resolution No. 176)

Note: Husband and wife who are both public officials/employees may file their SALN jointly or separately. The declarant who is single, widowed,
divorced or annulled or married to a private person shall tick off the box marked below as “Not Applicable”.

Joint Filing Separate Filing Not Applicable

DECLARANT: MINSU ACOSTA U. POSITION: WATCH MAN I

(Family Name) (First Name) (M.I.) UNIT: BARMM
ADDRESS: UPPER D’LAG PANDAG MAGUINDANAO DELSUR OFFICE: LGU-PANDAG
MAGUINDANAO DEL SUR OFFICE ADDRESS: BRGY. MALANGIT, PANDAG,
MAGUINDANAO DEL SUR

SPOUSE: N/A POSITION: N/A

(Family Name) (First Name) (M.I.) OFFICE: N/A
OFFICE ADDRESS: N/A

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN THE DECLARANT’S HOUSEHOLD

NAME DATE OF BIRTH AGE

N/A N/A N/A

ASSETS,LIABILITIESANDNETWORTH
(Properties owned by the abovenamed unmarried children and exclusive properties of the declarant’s spouse, in case of
separate filing, must be declared in the Separate Sheet/s)
1. ASSETS
a. RealProperties1

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,
and Improvement) Agricultural and Mixed As found in the Latest As found in the Latest
Tax Declaration BIR Zonal Value
YEAR MODE
Use)

NONE N/A N/A N/A N/A N/A N/A N/A

Total Value of Real Properties (Including those declared in the Additional Sheet, if any): 0
2
b. Personal Properties

DESCRIPTION ACQUISITION ACQUISITION

COST/AMOUNT
YEAR MODE

CELLPHONE 2024 PURCHASED 8,000

Total Value of Personal Properties (Including those declared in the Additional Sheet, if any):

Total Assets (a + b): 8,000

2. LIABILITIES3

1
Additional Sheet/s may be used, if necessary. In case of joint filing, the list should include the exclusive properties of the spouse.
2
Additional Sheet/s may be used, if necessary. In case of joint filing, the list should include the exclusive properties of the spouse.
3

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 3. LIABILITIES4

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

Current Liabilities
N/A N/A
N/A N/A
N/A N/A
8,000
NET WORTH (Total Assets - Total Liabilities): -0.000

BUSINESSINTERESTSANDFINANCIALCONNECTIONS5
(Business interests and financial connections of the spouse and unmarried children, if any, should be declared in the Separate Sheet/s)
I/We do not have any business interest or financial connection.

NAME OF BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF

ENTITY/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

RELATIVESINTHEGOVERNMENTSERVICE6
(Within the Fourth Degree of Consanguinity or Affinity, including 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
JULY JANE ALAGAO ACOSTA WIFE VENDOR UPPER D’LAG PANDAG MAGUINDANAO DEL SUR

I here by 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 here by 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 mein my household covering
previous years to include the year I first assume dofficein government.

Date: JANUARY 16, 2024

ACOSTA U. MINSU
(Signature of Declarant) (Signature of Co-Declarant/Spouse)

Government Issued ID: NATIONAL ID Government Issued ID: N/A

ID No.: 4802-7369-7612-4785 ID No.: N/A
Date Issued: MAY 13, 2022 Date Issued: N/A

SUBSCRIBEDANDSWORNtobeforemethisdayof ,affiantexhibiting to me the above-stated government issued

identification card

_______________________________________
(PersonAdministering Oath)

4
Additional Sheet/s may be used, if necessary.
5
Additional Sheet/s may be used, if necessary.
6
Additional Sheet/s may be used, if necessary.
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