Attachment A

Republic of the Philippines

Department of Education
Region XII
DIVISION OF SULTAN KUDARAT
Kenram Isulan Sultan Kudarat

Summary List of Filers

Statement of Assets, Liabilities and Net Worth
Calendar Year 20___

Secondary School/District:________________________
if Spouse is with government service, Please Check( √)
NAME OF EMPLOYEE (in alphabetical order) TIN
No. Position Net Worth if
PLEASE INDICATE
Last Name First Name Middle Name NAME OF SPOUSE/ EMPLOYER/ADDRESS Joint Filing
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Total Number of Filers: _________________
Total Number of Personnel Complement:__________________

Prepared by: Noted:

_____________________ ______________________________________
Secondary School Head/Disrict Head

Position: ________________________ Position: ________________________

Email Address: _______________________ Email Address: _______________________
Contact Number: _____________________ Contact Number: _____________________
Date: ______________________________ Date: ______________________________