Revised as of January 2015
Per CSC Resolution No. 1500088
Promulgated on January 23, 2015
SWORN STATEMENT OF ASSETS, LIABILITIES AND NETWORTH
As of December 31, 2019
(Required by R.A. 6713)
Note: Husband and wife who are both public official and employees may file the required statements jointly or separately.
Joint Filing Separate Filing Not Applicable
DECLARANT POSITION
(Family Name) (First Name) (M.I) AGENCY/OFFICE
ADDRESS Office Address
Spouse Name POSITION
(Family Name) (First Name) (M.I) AGENCY/OFFICE
Office Address
UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT'S HOUSEHOLD
NAME DATE OF BIRTH AGE
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*
DESCRIPTION EXACT ASSESSED CURRENT ACQUISITION
KIND
(e.g. lot, house, & lot, condominium LOCATION VALUE MARKET VALUE YEAR MODE ACQUISITION COST
As found in the Tax Declaration of Real
and improvements)
Property)
Subtotal : P -
b. Personal Properties*
Kind Year Acquired Acquisition Cost/Amount
Subtotal: P -
TOTAL ASSETS (a + b) P -
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ACQUISITION COST
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
TOTAL LIABILITIES : 0.00
NETWORTH: TOTAL ASSETS LESS TOTAL LIABILITIES: P -
* 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/ Nature of Business Interest Date of Acquisition of
BUSINESS ADDRESS
BUSINESS ENTERPRISE and/or Financial Connection Interest or Connection
RELATIVES IN THE GOVERNMENT SERVICE
(within the Fourth Degree of Consaguinity or [Link] also Bilas, Balae and Inso)
I/We do not know of any relative/s in the government service
NAME OF AGENCY/OFFICE
NAME OF RELATIVE RELATIONSHIP POSITION
AND ADDRESS
I hereby certify that these are true and correct statements of 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 consaguinity 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,
networth, 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 the
government.
Date: MARCH 11, 2020
Signature of Declarant Signature of Spouse
Government Issued ID Government Issued ID
ID No. ID No.
Date Issued Date Issued
SUBSCRIBED AND SWORN TO before me this 11th day of March, 2020 affiant exhibiting to me the above-stated
government issued identification card.
ALBERTO R. BOMEDIANO, JR.
Chief, Legal Division
PERSON ADMINISTERING OATH
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ALBERTO R. BOMEDIANO, JR.