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Sworn Statement of Assets, Liabilities and Net Worth

This document is a sworn statement of assets, liabilities and net worth that is required to be filed by public officials and employees under Philippine law. It includes details of the declarant's real and personal properties, liabilities, business interests, relatives in government service, and certification that the information provided is true and correct. The declarant authorizes government agencies to obtain documents verifying the disclosed financial information.

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30 views

Sworn Statement of Assets, Liabilities and Net Worth

This document is a sworn statement of assets, liabilities and net worth that is required to be filed by public officials and employees under Philippine law. It includes details of the declarant's real and personal properties, liabilities, business interests, relatives in government service, and certification that the information provided is true and correct. The declarant authorizes government agencies to obtain documents verifying the disclosed financial information.

Uploaded by

lou_mandi
Copyright
© Attribution Non-Commercial (BY-NC)
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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SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH

As of ________________________________
(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
DECLARANT: ADDRESS: Nethercott, Maria Lourdes (%a i&y Na e) (%irst Na e) )6 Rosas (t., *+i!"i&&e (ubdi"isio!, ,o!ce-cio! $, Mari3i!a ,ity 1411 Not Applic !le (%a i&y Na e)

Separate Filing
P. (M.$.)

Not Applicable
Ad i!istrati"e #fficer $$ %orei'! (er"ice $!stitute .% /%A 0&d'., )331 Ro2as 0&"d., Pasay ,ity 1311

POSITION: AGENCY/OFFICE: OFFICE ADDRESS:

SPOUSE:

(%irst Na e)

(M.$.)

POSITION: AGENCY/OFFICE: OFFICE ADDRESS:

UNMARRIED CHILDREN BELOW EIGHTEEN "#$% YEARS OF AGE LI&ING IN DECLARANT'S HOUSEHOLD
NAME DATE OF BIRTH AGE

ASSETS, LIABILITIES AND NETWORTH ( ncluding those of the spouse and unmarried children below eighteen (!"# years of age li$ing in declarant%s household# #( ASSETS ( Re l P)ope)tie*+
,IND
(e.'. reside!tia&, co ercia&, i!dustria&, a'ricu&tura& a!d i2ed use)

DESCRIPTION
(e.'. &ot, house a!d &ot, co!do i!iu a!d i -ro"e e!ts)

LOCATION

ASSESSED &ALUE

CURRENT FAIR MAR,ET &ALUE

AC-UISITION YEAR MODE

AC-UISITION COST

(As fou!d i! the *a2 /ec&aratio! of Rea& Pro-erty)

S.!tot l: !( Pe)*o/ l P)ope)tie*+


DESCRIPTION YEAR AC-UIRED AC-UISITION COST/AMOUNT

S.!tot l : TOTAL ASSETS " 0!%: 1( LIABILITIES+


NATURE NAME OF CREDITORS OUTSTANDING BALANCE

TOTAL LIABILITIES: NET WORTH : Tot l A**et* le** Tot l Li !ilitie* 2 + Additional sheet&s may be used' if necessary.

(age ! of )))

BUSINESS INTERESTS AND FINANCIAL CONNECTIONS


(of *eclarant &*eclarant%s spouse& +nmarried ,hildren -elow .ighteen (!"# years of Age /i$ing in *eclarant%s Household#

&0e do not ha$e any business interest or financial connection.


NAME OF ENTITY/BUSINESS ENTERPRISE BUSINESS ADDRESS NATURE OF BUSINESS INTEREST 3/OR FINANCIAL CONNECTION DATE OF AC-UISITION OF INTEREST OR CONNECTION

RELATI&ES IN THE GO&ERNMENT SER&ICE


(0ithin the Fourth *egree of ,onsanguinity or Affinity. nclude also -ilas' -alae and nso#

&0e do not 1now of any relati$e&s in the go$ernment ser$ice#


NAME OF RELATI&E RELATIONSHIP POSITION NAME OF AGENCY/OFFICE AND ADDRESS

$ hereby certify that these are true a!d correct state e!ts of y assets, &iabi&ities, !et +orth, busi!ess i!terests a!d fi!a!cia& co!!ectio!s, i!c&udi!' those of y s-ouse a!d u! arried chi&dre! be&o+ ei'htee! (14) years of a'e &i"i!' i! y househo&d, a!d that to the best of y 3!o+&ed'e, the abo"e5e!u erated are !a es of y re&ati"es i! the 'o"er! e!t +ithi! the fourth ci"i& de'ree of co!sa!'ui!ity or affi!ity. $ hereby authori6e the # buds a! or his7her du&y authori6ed re-rese!tati"e to obtai! a!d secure fro a&& a--ro-riate 'o"er! e!t a'e!cies, i!c&udi!' the 0ureau of $!ter!a& Re"e!ue such docu e!ts that ay sho+ y assets, &iabi&ities, !et +orth, busi!ess i!terests a!d fi!a!cia& co!!ectio!s, to i!c&ude those of y s-ouse a!d u! arried chi&dre! be&o+ 14 years of a'e &i"i!' +ith e i! y househo&d co"eri!' -re"ious years to i!c&ude the year $ first assu ed office i! 'o"er! e!t. /ate8 ______________________________

(Signature of *eclarant# 9o"er! e!t $ssued $/8 $/ No.8 /ate $ssued8

(Signature of ,o2*eclarant&Spouse# 9o"er! e!t $ssued $/8 $/ No.8 /ate $ssued8

SUBSCRIBED AND SWORN to before ide!tificatio! card.

e this

day of

, affia!t e2hibiti!' to e the abo"e5stated 'o"er! e!t issued

_______________________________________ ((erson Administering 3ath#

(age 4 of )))

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