SALN

Revised 2013
SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH
As of December 31, 2020
(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: PASATIEMPO JERRYVILL G. POSITION: SST-II

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPED – LALA NHS
ADDRESS: PUROK UPPER LUMBIA, LUMBIA DISTRICT OFFICE ADDRESS: LALA, PAGADIAN CITY
PAGADIAN CITY

SPOUSE: ASCABANO-PASATIEMPO GLENDEL A. POSITION: N/A

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: N/A
OFFICE ADDRESS: N/A
N/A

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

NAME DATE OF BIRTH AGE

JANNSENN A. PASATIEMPO APRIL 08, 2007 11

JEMMSENN A. PASATIEMPO APRIL 08, 2007 11
JAMMSENN A. PASATIEMPO NOVEMBER 12,2009 9
JENN VINCENT A. PASATIEMPO OCTOBER 22, 2013 5

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 LOCATION ASSESSED CURRENT FAIR ACQUISITION ACQUISITION

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

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: N/A
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION COST/AMOUNT

SUZUKI MOTORCYCLE 2015 Php. 110,000.00

SAMSUNG A50 CELLPHONE 2016 Php. 17,000.00
ELECTRONIC GADGET 2019 Php. 30,000.00
CASH 2018 Php. 400,999.35
Subtotal : Php 530,999.35
TOTAL ASSETS (a+b): Php 530,999.35
2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

SALARY LOAN RIZA CAPITAL LENDING SERVICES Php 149,626.00

SALARY LOAN GSIS Php 450,000.00

Subtotal: Php 599,626.00

NET WORTH : Total Assets less Total Liabilities = Php 279,716.21

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

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SALN
Revised 2013
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

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

N/A N/A N/A N/A
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 know of any relative/s in the government service)
NAME OF RELATIVE RELATIONSHIP POSITION NAME OF AGENCY/OFFICE AND ADDRESS
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

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: April 07, 2021

JERRYVILL G. PASATIEMPO
(Signature of Declarant) (Signature of Co-Declarant/Spouse)

Government Issued ID: Non Prof Drivers’ License Government Issued ID: N/A
ID No.: JO3-16-001167 ID No.: N/A
Issued at: Pagadian City Issued at: N/A
Date Issued: 07/09/2018 Date Issued: N/A

TIN: 939-677-357

SUBSCRIBED AND SWORN to before me this 7TH day of A p r i l , 2 0 2 1 , affiant exhibiting to me the above-
stated government issued identification card.

EMILIA O. ZOZOBRADO
(Person Administering Oath)
Administrative Officer V

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