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, 2021
(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: MANDUSIH SUKARNO S. POSITION: ADAS III

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPED/SIBUCO N.H.S.
ADDRESS: POBLACION, SIBUCO, ZAMBO. NORTE OFFICE ADDRESS:
POBLACION, SIBUCO, ZDN

SPOUSE: MANDUSIH NENEH A. POSITION: BARANGAY KAGAWAD

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: BLGU/PASILNAHUT
OFFICE ADDRESS: PASILNAHUT, SIBUCO, ZDN

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S HOUSEHOLD

NAME DATE OF BIRTH AGE

NUR AHMAD A. MANDUSIH 09/30/2011 10
SUKARNO A. MANDUSIH JR. 05/03/2013 8
PRINCESS SHEHANA A. MANDUSIH 05/03/2018 3
RODZMIR BRIAN A. MANDUSIH 03/01/2021 9mos

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,
(As found in the Tax Declaration of
and improvements) agricultural and mixed YEAR MODE
use) Real Property)

House Residential Poblacion, Sibuco, 700,000.00 800,000.00 2021 INHIRITED 800,000.00

Zamboanga del
Norte

Subtotal: 800,000.00
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT

MOTORCYCLE XRM 125 2016 67,500.00

Gadgets ( Mobile Phone and Laptop) 2018 33,500.00
Phone Real me 2020 7,100.00
Phone Vivo Y11 2021 6,000.00

Subtotal : 114,100.00

TOTAL ASSETS (a+b): 914, 100.00

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

Page 1 of 2
2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

Salary Loan ZORAYDA LENDING 300,000.00

Salary Loan EAST WEST BANK 120,000.00
Salary Loan GSIS 500,000.00

TOTAL LIABILITIES: Php 820,000.00

NET WORTH : Total Assets less Total Liabilities = Php 94,100.00
* 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
NENEH STORE POBLACION, SIBUCO, ZN OWNER 2016

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
NASIL S. MANDUSIH UNCLE PSSG PNP, ROXAS MPS, ROXAS, ZDN
ROGER A. JAMIL BROTHER IN-LAW PSSG PNP, BALIGUIAN MPS, BALIGUIAN, ZDN
BASIR A. JAMIL BROTHER IN-LAW CO1 BUCOR, SAN RAMON, ZC

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: 01/25/2022

SUKARNO S. MANDUSIH
(Signature of Declarant) (Signature of Co-Declarant/Spouse)

Government Issued ID: TIN Government Issued ID:

ID No.: 409 854 779 ID No.:
Date Issued: 3/26/2018 Date Issued:

SUBSCRIBED AND SWORN to before me this 25th day of January 2022, affiant exhibiting to me the above-
stated government issued identification card.

(Person Administering Oath)

Page 2 of 2
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, 2023
(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: MANDUSIH LAIKA D. POSITION: SUB-TEACHER

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPED/SIBUCO NHS
ADDRESS: JATIAN, SIBUCO, ZAMBO. NORTE OFFICE ADDRESS:
POBLACION, SIBUCO, ZDN

SPOUSE: 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

N/A
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,
(As found in the Tax Declaration of
and improvements) agricultural and mixed YEAR MODE
use) Real Property)

Subtotal:
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT

Iphone6 2018 8,000.00

Subtotal :

TOTAL ASSETS (a+b): 8, 000.00

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

Page 3 of 2
3. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

TOTAL LIABILITIES:
NET WORTH : Total Assets less Total Liabilities = Php 8,000.00
* 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

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
NASIL S. MANDUSIH UNCLE PSSG PNP, KATIPUNAN MPS, ROXAS, ZDN

AIYUB B. AMILASAN UNCLE PSSG PNP, POBLACION MPS, Sibuco, ZDN

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: 01/25/2022

AMNA U. EDDING
(Signature of Declarant) (Signature of Co-Declarant/Spouse)

Government Issued ID: PRC Government Issued ID:

ID No.: 2063452 ID No.:
Date Issued: 7/05/2023 Date Issued:

SUBSCRIBED AND SWORN to before me this 18th day of February 2024, affiant exhibiting to me
the above-stated government issued identification card.

(Person Administering Oath)

Page 4 of 2