Revi

sedasofJanuar
y2015
PerCSCResol
uti
onNo.1500088
Promul
gat
edonJanuary23,2015

SWORNSTATEMENTOFASSETS,
LIABI
LITI
ESANDNETWORTH
AsofDECEMBER31,
2018
(
Requi
redbyR.
A.6713)

Not
e:Husbandandwi
fewhoar
ebot
hpubl
i
cof
fi
cial
sandempl
oyeesmayf
il
ether
equi
redst
atement
sjoi
ntl
yorsepar
atel
y.
 Joi
ntFi
l
ing  Separ
ateFi
l
ing  NotAppl
i
cabl
e

DECLARANT: DOCTO JEFFREY S. POSI

TION: POLI
CEOFFI
CER1
(
Famil
yName) (
Fir
stName) (
M.I
.) AGENCY/
OFFI
CE: PNP/
RPHAU-
PRO6
ADDRESS: BLOCK14.
LOT3,
GOLDENRI
VERVI
LLAGE OFFI
CEADDRESS: CAMPGENERALMARTI
NTEOFI
LOB.
BRGY.
TACULI
NG,
BACOLODCI
TY DELGADO,
FORTSANPEDRO,
I
LOI
LOCI
TY

SPOUSE: N/A N/A N/A POSI

TION: N/
A
(
Fami
lyName) (Fi
rstName) (
M.I
.) AGENCY/
OFFI
CE: N/
A
OFFI
CEADDRESS: N/
A
N/
A

UNMARRI
EDCHI
LDRENBELOW EI
GHTEEN(
18)YEARSOFAGELI
VINGI
NDECLARANT’
SHOUSEHOLD

NAME DATEOFBI
RTH AGE
N/
A N/
A N/A
N/
A N/
A N/
A
N/
A N/
A N/
A
N/
A N/
A N/
A

ASSETS,LIABI
LITI
ESANDNETWORTH
(
Incl
udi
ngt
hoseofthespouseandunmarri
edchil
drenbel
owei
ght
een(
18)
year
sofagel i
vi
ngindecl
arant
’shousehol
d)
1.ASSETS
a. Real
Proper
ti
es*

DESCRI
PTI
ON KI
ND EXACT ASSESSED CURRENTFAI
R ACQUI
SITI
ON ACQUI
SITI
ONCOST
(
e.g.l
ot,
house (e.g.residenti
al, LOCATI
ON VALUE MARKETVALUE
andl
ot, commer cial
,
condomini
um industrial
, (
Asf
oundi
ntheTaxDeclar
ati
onof YEAR MODE
and agr i
culturaland Real
Proper
ty)
i
mprovements) mixeduse)
N/
A N/
A N/
A N/
A N/
A N/
A N/
A N/
A

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

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

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

Subt
otal
: N/
A
b.Per
sonal
Prope
rti
es*

DESCRI
PTI
ON YEARACQUI
RED ACQUI
SI
TI
ON
COST/
AMOUNT

GADGETS 2018 Php10,

000.
00
CL
OTHI
NG 2108 10,
000.
00
MOTORCYCL
E 2018 95,
000.
00
N/
A N/
A N/
A
Subt
ota
l:Php115,
000.
00

TOTALASSETS(
a :Php115,
+b) 000.
00

Page1of_
__
*Addi
ti
onalsheet
/smaybeused,
ifnecessar
y.

2. LI
ABI
LITI
ES*

NATURE NAMEOFCREDI
TORS OUTSTANDI
NGBALANCE

N/
A N/
A N/
A
N/
A N/
A N/
A
N/
A N/
A N/
A
N/
A N/
A N/
A
TOTALLI
ABI
LITI
ES: N/
A

NETWORTH:
Tot
alAsset
slessTot
alLi
abi
l
iti
es= Php115,
000.
00

*Addi
ti
onalsheet
/smaybeused,
ifnecessar
y.

BUSI
NESSI
NTERESTSANDFI
NANCI
ALCONNECTI
ONS
(
ofDecl
arant/
Decl
arant
’sspouse/Unmar
ri
edChi
l
drenBel
owEi
ght
een(
18)y
ear
sofAgeLi
vi
ngi
nDecl
arant
’sHousehol
d)
I
/Wedonothav
eanybusi
nessi
nter
estorf
inanci
alconnect
ion.
NAMEOFENTITY/
BUSI
NESS BUSI
NESSADDRESS NATUREOFBUSINESSI
NTEREST&/
OR DATEOFACQUISI
TIONOF
ENTERPRI
SE FI
NANCI
ALCONNECTION I
NTERESTORCONNECTI
ON
N/
A N/
A N/
A N/
A
N/
A N/
A N/
A N/
A
N/
A N/
A N/
A N/
A
N/
A N/
A N/
A N/
A

RELATI
VESI
NTHEGOVERNMENTSERVI
CE
(
Wit
hint
heFour
thDegr
eeofConsangui
nit
yorAf
fi
nit
y.I
ncl
udeal
soBi
l
as,
Bal
aeandI
nso)
I
/Wedonotknowofanyr
elat
ive/
sint
hegov
ernmentser
vice)
NAMEOFRELATI
VE RELATI
ONSHI
P POSI
TION NAMEOFAGENCY/
OFFI
CEANDADDRESS
JI
MMYB.DOCTO UNCLE TEACHER2 DEPED-
ISI
OELEMENTARY SCHOOL
N/
A N/
A N/
A N/
A
N/
A N/
A N/
A N/
A
N/
A N/
A N/
A N/
A
N/
A N/
A N/
A N/
A

Iherebycertif
yt hatt hesearetrueandcor r
ectstatement
sofmyasset s,l
iabi
li
ti
es,networt
h,business
i
nterestsandfi
nancialconnections,incl
udi
ngt hoseofmyspouseandunmar r
iedchi
ldrenbeloweight
een(18)yearsof
agelivi
nginmyhousehol d,andt hattothebestofmyknowl edge,t
heabove-
enumerat
edar enamesofmyr el
ati
vesinthe
governmentwit
hinthefourthcivildegreeofconsangui
nit
yoraf f
ini
ty.

Iherebyauthori
zetheOmbudsmanorhi s/herdulyauthori
zedrepresentat
ivetoobtai
nandsecurefr
om al l
appropriat
egov ernmentagencies,incl
udingt
heBureauofI nt
ernalRevenuesuchdocument sthatmayshowmyasset s,
l
iabil
it
ies,networ t
h,busi
nessinterestsandfi
nanci
alconnecti
ons,toincl
udethoseofmyspouseandunmar ri
edchi
ldren
below18y ear
sofagel i
vingwit
hmei nmyhouseholdcov er
ingprevi
ousy ear
stoincludetheyearIf
ir
stassumedoff
icein
government .

Dat
e: JANUARY28,
2019

N/A
(
Signat
ureofDecl
arant
) (
Signat
ureofCo-
Decl
arant
/Spouse)

Gover
nmentIssuedI
D: PNPI D Gover
nmentIssuedI
D: N/
A
I
DNo.: 18J260100 I
DNo.: N/
A
Dat
eIssued: 10/26/2018 Dat
eIssued: N/
A

SUBSCRIBEDANDSWORNt
obef
oremet
his dayof,
aff
iantexhi
bit
ingt
omet
hea
bov
e-s
tat
edgov
ernme
nti
ssue
d
i
denti
fi
cat
ioncar
d.

_
___
___
_____
_____
___
____
______
___
______
(
PersonAdmini
ster
ingOath)

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