SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH

As of
(Required by R.A 6713)

Note: Husband and Wife who are both public official and employees may file the required statement jointly 0r separately.

Joint filing Separate filing Not Applicable

DECLARANT: BANDINGUN SOHAIRA C. POSITION:

(Family Name) (First Name) (M.I.) AGENCY/OFFICE:
ADDRESS: BUBONG, POONA BAYABAO L.D.S OFFICE ADDRESS:

SPOUSE: POSITION:
(Family Name) (First Name) (M.I.) AGENCY/OFFICE:
OFFICE ADDRESS:

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

NAME DATE OF BIRTH AGE

___________________________________________________________ ____________________________________ ____________________________
___________________________________________________________ ____________________________________ ____________________________
___________________________________________________________ ____________________________________ ____________________________
___________________________________________________________ ____________________________________ ____________________________

ASSETS, LIABILITIES AND NET WORTH

(Including those of the spouse and unmarried children below eighteen (18) years of age living on declarant’s household)

1. ASSETS
a. Real Properties*
ASSESSED CURRENT FAIR
DESCRIPTION KIND EXACT VALUE MARKET VALUE ACQUISITION
(e.g. lot, house and lot, (e.g. residential,
condominium and commercial, industrial, LOCATION (As found in the Tax Declaration of ACQUISITION COST
improvements) agricultural and mixed use)
Real Property) YEAR MODE
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
Subtotal: ____________________
b. Personal Properties*
ACQUISITION
DESCRIPTION YEAR ACQUIRED
COST/AMOUNT
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
Subtotal: _______________
TOTAL ASSETS (a+b):___ ____________
2. LIABILITIES*
NATURE NAME OF CREDTION OUTSTANDING BALANCE
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
TOTAL ASSETS (a+b):____________________
NET WORTH: Total less Total Liabilities=____________________
*Additional sheet/s may be used, if necessary.

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 BUSINESS INTERESTS AND FINANCIAL CONNECTIONS
(of Declarant / Declaran’s spouse / Unmaried Children Below Eighteen (18) years of Age Living in Declarant’s Household)
I/We do not have any business interest or financial connection.
NATURE OF BUSINESS
NAME OF ENTITY/BUSINESS DATE OF ACQUISITION OF
BUSINESS ADDRESS INTEREST &/OR FINANCIAL
ENTERPRISE CONNECTION INTEREST OR CONNECTION

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

RELATIVE IN THE GOVERNMENT SERVICE

(Within the Fourth Degree of Consanguinity or Affinity include also Bilas,Balae and Inso)

I/We do not know any relative/s in the government service

NAME OF RELATIVE RELATION POSITION NAME OF AGENCY/OFFICE AND ADDRESS

HON. ROHAIDA B. PACALA MOTHER -IN VICE MAYOR LOCAL GOVERNMENT UNIT/POONA
-LAW BAYABAO
HON.NADJA B. PACALA GRAND BRGY. CHAIRWOMAN LOCAL GOVERNMENT UNIT/POONA
MOTHER- IN BAYABAO
-LAW

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 authorized 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 eighteen (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: National Bureau of Investigatin NBI Government Issued ID:
ID No.: R560KAGB59-DT270714 ID No.:
Date Issued: 05/30/2018 ILIGAN CITY 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)

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