SWORN STATEMENT OF ASSETS & LIABILITIES AND NETWORTH

As of December 2018
(Required by R.A. No. 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: PAANO KRISTIAN BERNARD C. POSITION : TEACHER I

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPARTMENT OF EDUCATION
ADDRESS: ZONE 5 BRGY. RAWIS OFFICE ADDRES: RAWIS NATIONAL HIGH SCHOOL
LAOANG, NORTHERN SAMAR BRGY. RAWIS, LAOANG N. SAMAR

SPOUSE:
N/A N/A N/A POSITION : N/A
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: N/A
OFFICE ADDRES: N/A

UNMARRIED CHILDREN BELOW 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
ASSESSED CURRENT FAIR
DESCPRITION KIND ACQUISITION
VALUE MARKET VALUE

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

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

Subtotal

b. Personal and Other Properties

ACQUISITION COST/
DESCPRITION YEAR ACQUIRED AMOUNT
LAPTOP 2016 ₱ 29,500.00
CELLPHONE 2016 ₱ 13,990.00
FURNITURES 2016 ₱ 130,000.00
CLOTHING 2016 ₱ 10,000.00
MOTORCYCLE 2016 ₱ 95,000.00
APPLIANCES 2016 ₱ 55,000.00

Subtotal ₱ 333,490.00
TOTAL ASSETS(A+B): ₱ 333,490.00
2. LIABILITIES
NATURE NATURE OF CREADITORS OUTSTANDING BALANCE
East West RB,INC. OCT 2016 - OCT 2019 East West - Catarman ₱ 320,000.00

Total Liabilities ₱ 320,000.00

NET WORTH : TOTAL ASSETS less TOTAL LIABILITIES ₱ 13,490.00
Note; Please use additional forms/sheets if necessary.

BUSINESS INTERESTS AND FINANCIAL CONNECTIONS

(of Declarant / Declarant’s spouse/ Unmarried children below Eighteen (18) years of Age Living Declarant’s household)
I / We do not have any business interest and other financial connections.

NATURE OF BUSINESS
NAME OF ENTITY / INTEREST &/OR DATE OF ACQUISITION OR
BUSINESS ADDRESS CONNECTION
BUSINESS ENTERPRISE FINANCIAL
CONNECTIONS
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 have any business interest and other financial connections.

NAME OF AGENCY/OFFICE
NAME OF RELATIVE RELATIONSHIP POSITION AND ADDRESS
FLOR C. PAANO MOTHER TEACHER III DEPED - LAOANG III
FLORY C. GALLARON AUNT TEACHER III DEPED - MONDRAGON

I hereby certify that these are true statements of my assets, liabilities, net worth, business interest
and financial connections, including those of my spouse and unmarried children below 18 years of age
living in my household, and that to the best of my knowledge, the above enumerated are names of relatives
in the government within the fourth civil degree of consanguinity or affinity.

I hereby authorize the Ombudsman or his/her authorized representatives 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 the government.

Date:

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

Government Issued ID: PRC ID Government Issued ID:

ID No.: 1430695 ID No.:
Date Issued : 1/11/2016 Date Issued :
 SUBSCRIBED AND SWORN to before me this _______ day of ___________, affiant exhibiting to
me the above – stated government issued identification card.

( Person Administering Oath)

BRGY. RAWIS, LAOANG N. SAMAR