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, 2019
(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 ANTIPUESTO JOSEPHA E. POSITION: TEACHER I

:
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPED - PPC
ADDRESS: VIRGINIA HOA, PROJECT 2, BGY. SICSICAN, OFFICE ADDRESS: BGY. STA. MONICA, PPC
PUERTO PRINCESA CITY, PALAWAN

SPOUSE: Not Applicable POSITION: Not Applicable

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: Not Applicable
OFFICE ADDRESS: Not Applicable

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S HOUSEHOLD
NAME DATE OF BIRTH AGE
NONE NONE NONE
NONE NONE NONE
NONE NONE NONE
NONE NONE NONE

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)

Virginia HOA, 2016 Loan

House Residential Siciscan, Puerto 300,000.00 350,000.00 350,000.00
Princesa City
Lot Residential Virginia HOA, 2014 Cash
Sicsican, Puerto
150,000.00 200,000.00 Installment 200,000.00
Princesa City
NONE NONE NONE NONE NONE NONE NONE NONE
NONE NONE NONE NONE NONE NONE NONE NONE
NONE NONE NONE NONE NONE NONE NONE NONE
NONE NONE NONE NONE NONE NONE NONE NONE
NONE NONE NONE NONE NONE NONE NONE NONE
Subtotal: 550,000.00
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION COST/AMOUNT

Personal Belongings 2019-2020 33,500.00

Wrangler Jeep 2019 50,000.00
Electronic gadgets and Appliances 2019-2020 35,177.00
Honda 200XR 2017 70,000.00
NONE NONE NONE
NONE NONE NONE
NONE NONE NONE
NONE NONE NONE
Subtotal : Php 188,677.00

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 TOTAL ASSETS (a+b): Php738,677.00
2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

Salary Loan East West Rural Bank 411,000.00

Multi-purpose Loan GSIS 89,000.00
NONE NONE NONE
NONE NONE NONE
TOTAL LIABILITIES: Php 500,00.00
NET WORTH : Total Assets less Total Liabilities = Php 238,677.00
* 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
NONE NONE NONE NONE
NONE NONE NONE NONE
NONE NONE NONE NONE

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
NONE NONE NONE NONE
NONE NONE NONE NONE
NONE NONE NONE NONE

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: January 11, 2021

______________________________

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

Government Issued ID: PRC Government Issued ID:

ID No.: 1100330 ID No.:
Date Issued: August 22, 2011 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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