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
(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
DECLARAN: BACCAY JAYSON C. POSITION: POLICE STAFF SERGEANT
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: PHILIPPINE NATIONAL POLICE
ADDRESS: P-7, LALAUANAN TUMAUINI ISABELA OFFICE ADDRESS: ISABELA POLICE PROVINCIAL
OFFICE
BALIGATAN, CITY OF ILAGAN,
ISABELA
SPOUSE: BACCAY SHERYL ANN M. POSITION: N/A
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: N/A
OFFICE ADDRESS: N/A
UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S HOUSEHOLD
NAME DATE OF BIRTH AGE
JENNY HANS SOL M. BACCAY SEPTEMBER 1, 2013 8
SEAN JAYE M. BACCAY AUGUST 27, 2015 6
HANNA JAYE M. BACCAY JANUARY 24,2017 4
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*
EXACT ASSESSED CURRENT ACQUISITION ACQUISITION
DESCRIPTION KIND LOCATION VALUE FAIR COST
(e.g. lot, house and (e.g. residential, MARKET
lot, condominium commercial,industrial, VALUE
and improvements) agricultural and mixed (As found in the Tax
use) Declaration of YEAR MODE
Real Property)
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
CELLPHONE 2021 10,000.00
Subtotal: P 10,000.00
TOTAL ASSETS (a+b): P 10,000.00
* Additional sheets/s may be used, if necessary.
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2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
SALARY LOAN AFMBAI 315,000.00
SALARY LOAN AMSLAI 508,776.27
E56 LOAN AFPMBAI 5,902.75
SALARY LOAN PSSLAI 6,200.00
TOTAL LIABILITIES: P 835,879.02
NET WORTH : Total Assets less Total Liabilities = (P 825,879.02)
* 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
JOEL C.BACCAY BROTHER TEACHER DEPARTMENT OF
EDUCATION/TUMAUINI, ISABELA
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: JANUARY 24, 2021
(Signature of Declarant) (Signature of Co-Declarant/Spouse)
Government Issued ID: PRC Government Issued ID: N/A
ID No.: 0046047 ID No.: N/A
Date Issued: 01/04/ 2010 Date Issued: N/A
SUBSCRIBED AND SWORN to before me this 24TH day of JANUARY 2021 , affiant exhibiting to me the
above-stated government issued identification card.
PLTCOL JEFFREY D RAPOSAS
CHIEF, IPHRDD
__________________________________________
(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 DECEMBER 31, 2020
Sample additional sheet/s for the declarants)
NAME POSITION:
(Family Name) (First Name) (M.I.) AGENCY/OFFICE:
ASSETS, LIABILITIES AND NETWORTH
1. ASSETS
a. Real Properties*
DESCRIPTION KIND EXACT ASSESSED CURRENT FAIR ACQUISITION ACQUISITION
(e.g. lot, house and (e.g. residential, LOCATION VALUE MARKET COST
lot, condominium commercial,industrial, VALUE
and improvements) agricultural and mixed (As found in the Tax Declaration of
use) Real Property)
YEAR MODE
b. Personal Properties*
ACQUISITION
DESCRIPTION YEAR ACQUIRED
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 INTEREST OR
FINANCIAL CONNECTION CONNECTION
Page 3 of 3
