Make your own free website on Tripod.com

Sworn Statements of Assets, Liabilities and Net Worth,
Disclosure of Business Interests and Financial Connections,
And Identification of Relatives in the Government Service
as of December 31, 2000
(Required by R.A. No. 6713)

Name: Position:
Address: Office
    Office Address:
Spouse Name: Position:
    Office:
Unmarried Children below 18 years of age:  

Name

Date of Birth

1.  
2.  
3.  
4.  
5.  
   

ASSETS, LIABILITIES AND NET WORTH

1. ASSETS
a. Real Properties
Kind Location Year Acquired Mode of Acquisition Assessed Value Current Fair Market Value Acquisition Cost
Land, Bldg., Etc. Improvement
               
               
               
               
               
               
TOTAL  
 
b. Personal and Other Properties
Kind Year Acquired Acquisition Cost
     
     
     
     
     
     
     
     
TOTAL    
 
2. LIABILITIES
Nature Amount
   
   
   
   
TOTAL  
   
NET WORTH [Total Assets (1a + 1b) less Total Liabilities (2)]  
     
     
B. BUSINESS INTEREST AND FINANCIAL CONNECTIONS
Do you have any business interest and other financial connections, including those of your spouse and unmarried children below 18 years of age living with your household? ( ) yes ( ) no.  If yes, give particulars
Name Position relationship Name/address of Office
       
       
       
       
       
 

I hereby certify to the best of my knowledge and information that these are true statements of my assets, liabilities, net worth, business interest and financial connections, including those of my spouse and unmarried children below 18 years of age and names of my relatives in government as of December 31, 2000, as required by and in accordance with Republic Act No. 6713.

I hereby authorize the Ombudsman or his 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 years I first assumed office in the Government.

Signed: _______________________

 

 

| Home | SALs | Representives | Senators | Cabinet | Vice President | President |

All Rights Reserved Pagbabago@Pilipinas
Thursday, July 26, 2001 08:19:00 PM