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, 2022

(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

DECLARANT: CATINDIG ALLEN MIJILLANO POSITION: Sangguniang Kabataan

Kagawad
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: Barangay Gimaloto
ADDRESS: PUROK 2, OFFICE ADDRESS: Gimaloto, Sorsogon City
GIMALOTO
SORSOGON CITY

N/A
SPOUSE: POSITION: N/A

DECLARENT: 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

N/A N/A N/A

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 KIND EXACT ASSESSED CURRENT FAIR ACQUISITION ACQUISITION

(e.g. lot, house and (e.g. residential, LOCATION VALUE MARKET VALUE COST
lot, condominium commercial, industrial,
and improvements) agricultural and mixed (As found in the Tax Declaration of
Real Property)
YEAR MODE
use)

N/A N/A N/A N/A N/A N/A N/A N/A

Subtotal:
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT

SMART PHONE MAY, 2022 7,000

Subtotal : 7,000 Php

TOTAL ASSETS (a+b): 7,000 Php

* Additional sheet/s may be used, if necessary.

LIABILITIES*

OUTSTANDING
NATURE NAME OF CREDITORS
BALANCE

N/A N/A N/A

TOTAL LIABILITIES:
NET WORTH : Total Assets less Total Liabilities = 7,000 Php
* 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 BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION

ENTITY/BUSINESS INTEREST &/OR FINANCIAL OF INTEREST OR
ENTERPRISE 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

N/A N/A N/A N/A

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:

(Signature of Declarant) (Signature of Co-Declarant/Spouse)

Government Government
Issued ID: GOVERNMENT ID Issued ID:
ID No.: PCN: 6325-9831-6890-3759 ID No.:
Date Issued: AUGUST 2020 Date Issued:

SUBSCRIBED AND SWORN to before me this day of , affiant exhibiting to me the

above-stated government issued identification card.

EMELYN C. VALENCIA
Officer-in-charge
Administrative Department