School Heading

Date
ENGR. EDGARD C. DOMINGO, PhD, CESO V
Schools Division Superintendent
DepEd Division of Pampanga
City of San Fernando (P)

Attention: Administrative Officer V

SIR:

This Office submits herewith the scanned copies of duly accomplished Statements of Assets, Liabilities and Net Worth and Disclosure of Business Interests and Financial Connections of the following Teachers/Employees of (School Name), (District/Cluster),
for the year ending December 31, 2022, as follows:

Summary List of Filers

Statement of Assets, Liabilities and Networth

LEVEL
Step Date of Date of Months in Service in
NAME Position
Delivery Unit Increment as Monthly Basic Salary (as of Net Worth (as of December Appointment Appointment SY 2021-2022
No. School ID District/Cluster (Last name, First name Middle (as per latest TIN
(School Name) ( Indicate if of December December 31, 2022) 31, 2022) SALN (Original / Re- (Last Promotion, (September 13, 2021 -
Name) appointment)
Elementary/Juni 31, 2022 employment) if applicable) June 24, 2022)
or HS/SHS)

1
2
3
4
5
6
7
8
Insert additional rows if necessary

Total Number of Teachers/Employees who filed their SALNs:

List of Teachers/Employees who did not file their SALNs

LEVEL
Step Date of Date of Months in Service in
NAME Position
Delivery Unit Increment as Monthly Basic Salary (as of Net Worth (as of December Appointment Appointment SY 2021-2022
No. School ID District/Cluster (Last name, First name Middle (as per latest TIN
(School Name) ( Indicate if of December December 31, 2022) 31, 2022) SALN (Original / Re- (Last Promotion, (September 13, 2021 -
Name) appointment)
Elementary/Juni 31, 2022 employment) if applicable) June 24, 2022)
or HS/SHS)

1
2
3
4
5
6
7
8

Total Number of Teachers/Employees who did not file their SALNs:

Very Truly Yours,

Signature Over Printed Name of School Head

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Encl.:
As stated.

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