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STATEMENT OF ASSETS, LIABILITIES, AND NET WORTH v1.0

I. ABOUT USING THIS ELECTRONIC VERSION OF THE SALN (eSALN)The eSALN is a Microsoft Excel version of the SALN which facilitates filling out and printing of the form. Make sure that Macrosare enabled to run when you open the eSALN template.

With Excel 2003, you can do this by first selecting your macro security level.1. On the Tools menu, point to Macro, and then click Security.2. On the Security Level tab, select Medium or Low. With the Medium setting, you'll be given an option to enable macroswhen you open eSALN.

You also need to allow unsigned macros to run, the Trust all installed add-ins and templates check box must be selected onthe Trusted Publishers tab of the Security dialog box. This option is selected by default. If it is not selected (recommended),Excel allows you to run only macros that have trusted digital signatures.

1. On the Tools menu, point to Macro, and then click Security.2. On the Trusted Publishers tab, select the Trust all installed add-ins and templates check box.

With Excel 2007, when the Security Warning appears that Macros have been disabled, just click Options... and select Enablethis content.

After changing the security settings, exit Excel first and re-open the eSALN template.

SOME IMPORTANT TIPS: Pop-up comments are situated throughout the form whenever there is a small red triangle. Simply hover your mouse on it tosee the comment. You can quickly move from one field to the next by pressing TAB. For entries which can be split into two lines, e.g. Address, press Alt-Enter to create a new line. Use Excel's built-in page breaking tool to insert page breaks when printing, i.e. go to where you want a page break, then onthe Insert menu, click Page Break.

To download the latest version of the eSALN, go to http://www.csc.gov.ph/cscweb/saln.html

II. ABOUT THE SALNThe SALN contains information about ownership of assets as well as ones liabilities. Every government employee, from the

President to every rank-and-file employee, is required by law to submit this form. The governing law is Republic Act No. 6713,otherwise known as the Code of Conduct and Ethical Standards for Public Officials and Employees. The law is based on theConstitutional provision that A public officer or employee shall, upon assumption of office and as often thereafter as may berequired by law, submit a declaration under oath of his assets, liabilities and net worth.

Liabilities and PenaltiesYou may note that you are not required to attach any documents to vouch or substantiate the information disclosed. However,the SALN is made under oath. Falsification of information or failure to file or report information required to be reported maysubject you to disciplinary/criminal action. Knowing and willful falsification of information required to be reported may alsosubject you to criminal prosecution.

Penalties under RA 6713 may be any of the following: Imprisonment = five years Fine = P5,000 Dismissal from the service

Assistance in Filling Out the SALNIf you need assistance in completing the SALN form, contact the Integrated Records Management Office (IRMO) of the CSC attelephone numbers 931-7981, 931-7987, 932-2293, and 951-4628, or email queries to [email protected].

III. ABOUT THE ANNUAL DECLARATION (AD)

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, ,

1. The Baseline Declaration (BD), and2. The Annual Declaration (AD).

Remember that the BD is to be completed only once. Once you have submitted the BD, only changes in your status need to bereported in the next reporting periods using the AD.

Who Must FileAll public officials1 and employees, whether regular or under temporary status, are required to file the SALN.

Who do not need to file Public officials serving in an honorary capacity, without credit or pay; Temporary laborers; and, Casual or temporary (not in the regular plantilla of agency) and contractual workers.2

1Under Section 2 (b) of Republic Act No. 3019, the term public officer includes elective and appointive officials andemployees, permanent or temporary, whether in the classified or unclassified or exempt service, receiving compensation, evenif nominal, from the government. Under Section 3 (b) of Republic Act No. 6713, the term public officials includes elective andappointive officials and employees, permanent or temporary, whether in the career or non-career service, including military andpolice personnel, whether or not they receive compensation, regardless of the amount.

2As implemented by Section 1.a. Rule VIII of the Rules Implementing the Code of Conduct and Ethical Standards for PublicOfficials and Employees, as amended by CSC Resolution No. 06-0232 dated 1 February 2006.

When to File

The AD is due on or before April 30 of each year, where the employee has previously submitted a BD.

The first AD shall contain information starting from the day immediately following the cut-off date of an employees BD, up toDecember 31 of the year of the BD cut-off. The subsequent ADs of an employee shall be for the period January 1 to December31 of each succeeding year.

The AD must also be accomplished within 30 days of an employees separation from Government service, statements of whichmust cover January 1 up to the employees last day in office.

Where to FileAccomplish the forms in triplicate and submit the same to your Human Resource Management Office (HRMO), PersonnelOffice, or Administration Office.

Further, under CSC Resolution No. 06-0231 dated February 1, 2006, the Chief/Head of the Personnel/Administrative Divisionor Unit/HRMO shall transmit all original copies of the SALNs received, on or before June 30 of every year, to the concerned

offices, as indicated in the table of SALN Repository Agencies in the manual.

Must all the forms in triplicate be originally signed?Since your SALN will be submitted to various repository agencies, it is best to submit the accomplished SALN forms intriplicate originals, that is, originally signed and originally subscribed on all three originals. Be sure to retain a copy of yourSALN and have the same received as proof of your SALN submission.

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As of

*For Joint Filing, make 2 entries for Name, Position, Declarant's Annual Gross Salary, Name of Agency, and Office Address

* Annual Gross Salary refers to ALL amounts received by declarant from Government service

Name: Position: Company:

my last SALN submission

last SALN submission

since my last SALN submission

my household since my last SALN submission

years of age living in my household since my last SALN submission

years of age living in my household since my last SALN submission

D. ACQUISITIONS AND DISPOSALS OF ASSETS AND LIABILITIES

Year Cost(MarketValue of Asset)

Acquisition

(Disposal of Asset)

Mode

Kind of Real Property/

Type of Vehicle and

Plate No. Acquired

(Disposed)

Estimated

Fair Market

Value (Php)Location of Real Property/

Cert. No. and Place of Reg of

Vehicle

Annual Gross Family Income

Asse

Val

1. Acquisition/Disposals of Real Properties and/or Vehicles of Declarant/Spouse/Declarant's Children Below 18 Y

of Age Living in the Household of Declarant, regardless of amount

SWORN STATEMENT OF ASSETS, LIABILITIES, AND NET WORTH

DISCLOSURE OF BUSINESS INTERESTS AND FINANCIAL CONNECTIONS

AND IDENTIFICATION OF RELATIVES IN THE GOVERNMENT SERVICE (Required by R.A. No. 6713)

* Annual Gross Family Income refers to income of declarant, spouse, and declarant's children below 18 years of age living in declarant's household

Name of Agency/Office Office Address

Additional Children of Declarant Below 18 Years of Age Living in Household of Declarant since last SALN submissio

Date of BirtName Name

Instructions for Assets, Liabilities, and Business Interests/Financial Connections: Liquidation/disposal of assets, retirement/reduction of liabilities, and term

business interests/financial connections must be enclosed in parenthesis (xxx) to distinguish the same from acquisitions of assets, incurrence of new liabilities, and

of business interests and financial connections.

Spouse Information:

N/A N/AN/A

Date of Birth

B. IF DECLARANT HAS NOTHING TO DECLARE

C. IF DECLARANT HAS SOMETHING TO DECLARE

Instructions for all assets: Declare assets whether the declarant/spouse/chi ld is the legal owner (name appearing on the instrument of title) or the beneficial ow

(property is in the name of another person but ownership pertains to declarant/spouse/child, under a trust arrangement ).

(Not applicable to vehic

Middle Name

Home Address Declarant's Annual Gross SalarPosition

(Annual Declaration)

A. DECLARANT'S PERSONAL INFORMATION AND EMPLOYMENT

Last Name First Name

There have been no acquisitions and no disposals of vehicles pertaining to me / my spouse / my children below 18 years of age living in my household since my

There have been no acquisitions and no disposals of real properties pertaining to me / my spouse / my children below 18 years of age living in my household since

I have no children below 18 years of age living in my householdI am married I am not married

There have been no acquisitions and no disposals/liquidations of investments pertaining to me / my spouse / my children below 18 years of age living in my household

There have been no acquisitions and no disposals of other personal properties to declare pertaining to me / my spouse / my children below 18 years of age living in

There have been no incurrence of new liabilities and no retirement/reduction of existing liabilities to declare pertaining to me / my spouse / my children below 18

There have been no acquisitions and no terminations of business interests and financial connections to declare pertaining to me / my spouse / my children below 18

I don't know of any relative who joined Government or was separated therefrom since my last SALN submission

Joint Filing

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Total (Php) 0

Acquisition

Cost

N/A(equity paid) (premiums paid)

N/A

N/Aplacements

N/A

N/A Options(premiums paid)

N/A Others(premiums paid)

Acquisition

Cost

Cash on Hand/ N/ABank accounts

N/A

N/A

GSIS, PAGIBIG loans

Furniture, antiques N/A

Jewelry N/A

N/A

purchases

N/A

properties

Others N/A Loans from otherinstitutions

Others

N/A

N/A

N/A

N/A Judgment debts N/A

N/A

N/A

N/A

N/A

N/A

(Amount PaOutstanding

Balance/Increase

N/A

N/A

N/A

N/A

N/A

D.2.2. Other Personal

Property Acquired

(Disposed)

D.2.3. Liability Incurred

(Paid)

N/A

N/A

(Value of

Liquidated Asset)

N/A

N/A

N/A

Personal loans N/A

(Value of

Liquidated As

Instructions: Declare each item with a fair market value of Php 50,000 or more , even if the same was acquired at no cost or at less cost. Market value must be determ

as of the date of declaration. Items with less value may be declared in lump sum as "Others". However, if "Others" amounts to more than Php 100,000 , each item must

listed. Mark the properties to be declared and make the corresponding entry for the Acquisition Cost/Value of Liquidated Asset.

0

N/A

D.2.1. Investment Acquired

(Disposed)

Bonds

Pre-need plans

Time deposits

Equity in partnerships N/A

N/AMoney marketN/A

Stocks N/A

(Value of

Liquidated Asset)

Acquisition

Cost

Equity in installment

Intellectual

Acquisitio

Nature of Business

Connection

Name of Entity

2. Acquisitions/Disposals/Liquidations of Investments/Other Personal Properties; Incurrence/Retirement/ Reduction

Liabilities -- of Declarant/Spouse/Declarant's Children Below 18 Years of Age Living in the Household of Declarant

D.2.1. Investment

Acquired (Disposed)

E. ACQUISITION/TERMINATION OF BUSINESS INTERESTS/FINANCIAL CONNECTIONS BY

DECLARANT/SPOUSE/DECLARANT'S CHILDREN BELOW 18 YEARS OLD LIVING IN HOUSEHOLD O

DECLARANT

Date ofDeclarant, Spouse, or

Instructions: Declare each acquired item which generates gross annual receipts of Php 50,000 or more . Items with less value may be declared in lump sum as "Other

However, if "Others" amounts to more than Php 100,000 , each item must be listed. Termination of Business Interests or Financial Connections previously reported,

regardless of current gross annual receipts, must be reported.

Address

Child [Put Name] Interest/Financial

(Terminatio

Receivables

Mortgage payables

Guaranty liabilities

Surety liabilities

payments onleases/rentals

Deposits/advanced

Bank loans

Accounts payables

N/A

Trust funds

Private insurance

Educational plans

N/A

N/A

Mutual funds

N/A

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Declarant's Signature: Date: TIN:

Community Tax Cert No: Issued In: Issued On:

In case of joint filing:

Spouse 's Signature: ______________________________________ Date: __________ TIN: ______________________________

Community Tax Cert. No.: ________________ Issued In: _________________________ Issued On: ______________________________

Notes to Sworn Statement of Assets, Liabilities, and Net Worth, Disclosure of Business Interests and Financial Connections,

Instructions: Up to the 4th civ il degree of relationship, either of consanguinity or affinity, including bilas, inso, and balae.

Name of Relative Office/Address

G. INCORPORATION BY REFERENCE AND STATEMENT:

I further undertake to produce all supporting documents for each of the entries herein made when required.

F. DECLARANT'S RELATIVES IN THE GOVERNMENT

I am fully incorporating to this statement my Baseline Declaration for the year _2007_ and subsequent declarations from __N/A_ through __N/A_

hereby certify to the best of my knowledge and information that these SALN statements collectively are complete and true statements of my assets,

liabilities, net worth, business interests, and financial connections, including those of my spouse and my children below 18 years of age living in my

household, and the names of my relatives in the Government, as of January 0, 1900, as required by and in accordance with Republic Act No. 6713. I

further certify that no assets, liabilities, business interests, financial connections, and relatives in the Government other than those declared herein are

known to me, my spouse, and my children below 18 years of age living in my household.

I hereby authorize the Ombudsman or his duly authorized representative to obtain and secure from all appropriate government agencies, includin

the Bureau of Internal Revenue, such documents that may show such assets, liabilities, net worth, business interests, and financial connections, includthose of my spouse and my children below 18 years of age living in my household covering previous years, including the year I first assumed office in

Government.

(Person Administering Oath)

Relationship Position (Separated)

and Identification of Relatives in the Government Service:

SUBSCRIBED AND SWORN TO before me on this _______ day of ________________________, 20_____, affiant(s) exhibiting his/her/their Commu

Tax Certificate(s) as indicated above.

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D.2.1. INVESTMENT ITEM

Option to Declare: Investments(If total of all items with FMV less than Php 50,000 is Php 100,000 or less)

D.2.2. OTHER PERSONAL PROPERTY

Option to Declare: Other Personal Properties(If total of all items with FMV less than Php 50,000 is Php 100,000 or less)

D.2.3. LIABILITIES

Option to Declare: Liabilities(If total of all items with OB less than Php 50,000 is Php 100,000 or less)

ANNUAL GROSS FAMILY INCOME

Income Source Annual

Income

Annual Gross Salary

Declarant 0

Income from Real Properties and Vehicles

Income from Investment Items

Stocks

Bonds

Mutual funds

Trust funds

Private Insurance

Educational plans

Pre-need plans

Time deposits

Money market placements

SALN ANNUAL DECLARATION DETAILS

for

as of

Instructions: This AD Details worksheet will assist you in calculating the totals that you would need in the main AD form. It has four (4) main sections:

1) D.2.1. Investment Item

2) D.2.2. Other Personal Property

3) D.2.3. Liability

4) Annual Gross Family Income

Some sections have a Help button that will show/hide the associated procedure in coming up with the calculations.

If you would like to put a comment or justification for an item, write down a number at the Reference Note and write down a corresponding description

at the Notes section at the bottom of the main AD form.

Type of Income

Do not declare these items in the SALN at all

Declare in lump sum as Others (Items reclassified to Others will be marked with an asterisk *)

Declare in the respective kind of asset



Declare in the respective kind of liability



Declare in the respective kind of asset

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Income from Other Personal Properties

Cash on hand/Bank accounts

Receivables

Deposits/advanced payments on leases/rentals

Furniture/antiques

Jewelry

Equity in installment purchases

Intellectual properties

Others

Income from Liability

Personal loans

Bank loans

Accounts payables

GSIS, PAGIBIG loans

Mortgage payables

Surety liabilities

Guaranty liabilities

Judgment debts

Loans from other institutions

Others

Income from Business Interests and Financial Connections

Income from Other Sources

TOTAL 0

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