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: POSITION:
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: AROROY MUNICIPAL HOSPITAL
ADDRESS: POBLACION, AROROY, MASBATE OFFICE ADDRESS: JABOYOAN, AROROY, MASBATE

SPOUSE: POSITION: BUSINESSMAN

(Family Name) (First Name) (M.I.) AGENCY/OFFICE:
OFFICE ADDRESS: POBLACION, AROROY, MASBATE

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

NAME DATE OF BIRTH AGE

MARCH 13, 2002 18
DECEMBER 3, 2003 17
SEPTEMBER 15, 2005 15

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 COST

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

LOT RES. POBLACION 11,500.00 57,620.00 1995 PURCHASED 20,000.00

HOUSE RES. POBLACION 21,520.00 215,190.00 2000 CONSTRUCT 200,000.00
LAND AGRI. AMBOLONG 750.00 1,880.00 2002 PURCHASED 40,000.00
LOT RES. JABOYO-AN 8,800.00 40,000.00 2004 PURCHASED 10,000.00
HOUSE RES. POBLACION 136,632.00 546,450.00 2000 PURCHASED 900,000.00
LOT RES. POBLACION 24,420.00 122,120.00 2010 PURCHASED

LOT RES. POBLACION 111,800.00 222,360.00 2013 PURCHASED 130,000.00

BLDG MIXED USED POBLACION 1,037,560.00 1,729,270.00 2013 CONSTRUCT 1,700,000.00
LOT RES LEGAZPI 10,500.00 70,000.00 2019 LOAN 600,000.00
LOT RES MASBATE 5,630.00 112,500.00 2014 PURCHASED 150,000.00
LOT RES MANILA 46,730.00 467,235.00 2011-15 INSTALLMENT 3,300,000.00
HOUSE RES MANILA 949,490.00 2,373,730.00 2011-15 INSTALLMENT

LOT RES MASBATE 140,900.00 543,000.00 2014-16 INSTALLMENT 1,000,000.00

LOT RES BAGA-UMA 88,650.00 433,260.00 2017 PURCHASED 500,000.00
LAND RES BAGA-UMA 107,820.00 539,100.00 2020 PURCHASED 800,000.00
Subtotal: 9,350,000.00
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION COST/AMOUNT

TOYOTA FORTUNER-SUV UCPB CAR LOAN 2011-2012 1,400,000.00

DENTAL EQUIPTMENT AND FURNITURES 1990-2014 700,000.00
JEWELRIES 1998-2015 750,000.00
PRE NEED PLANS AND INSURANCES 2000-2018 4,000,000.00
TOYOTA FURTUNER METROBANK CAR LOAN 2015-2016 1,400,000.00
3 HOWO DUMP TRUCK DAIRIN LOAN 2017-2018 8,600,000.00
4 HOWP DUMP TRUCK UCPB LOAN 2017-2019 12,000,000.00
3 SIMO TRUCK ORIX METRO LOAN 2018-2019 6,600,000.00
Subtotal : 35,450,000.00
TOTAL ASSETS (a+b): 44,800,000.00
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2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

DUMP TRUCK LOAN 12,000,000.00

CASH LOAN 7,500,000.00
DUMP TRUCKS LOAN 4,950,000.00

TOTAL LIABILITIES: 24,450,000.00

NET WORTH : Total Assets less Total Liabilities = 20,350,000.00

* 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
POBLACION, AROROY, MASBATE DENTAL SERVICES FEBRUARY 2008
POBLACION, AROROY, MASBATE BUY AND SELL JANUARY 2009
POBLACION, AROROY, MASBATE HAULING NOVEMBER 8, 2017

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
SISTER NURSE AROROY MUNICIPAL HOSPITAL
BROTHER IN LAW ADMIN. OFFICER AROROY MUNICIPAL HOSPITAL
SISTER IN LAW MUN COUNCILOR AROROY MUNICIPAL BUILDING

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 3, 2021

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

Government Issued ID: PRC Government Issued ID: LTO DRIVERS LICENSE
ID No.: ID No.:
Date Issued: JULY 17, 2019 Date Issued: JULY 7, 2017

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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