SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH

As of DECEMBER 2014
(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

DAVID

MARIANNE

T.

(Family Name)

(First Name)

(M.I.)

DECLARANT

Not Applicable
TEACHER 3

POSITION:

:
ADDRESS:

#10 A PUROK 4 BRGY. LARA. CITY OF

AGENCY/OFFICE:

DEPED

OFFICE ADDRESS:

CITY OF SAN FERNANDO (P)

SAN FERNANDO, PAMPANGA

DAVID

ROBERTO

C.

(Family Name)

(First Name)

(M.I.)

SPOUSE:

DRIVER

POSITION:
AGENCY/OFFICE:

N/A

OFFICE ADDRESS:

N/A

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANTS HOUSEHOLD
NAME

DATE OF BIRTH

ROANNE T. DAVID
ROMAR T. DAVID
ROB LAWRENCE T. DAVID
LARA NICOLE T. DAVID

AGE

MAR. 30, 2001

MAY 05, 2003
JULY 27, 2005
MAR. 11, 2013

13 yrs. old
11 yrs. Old
9 yrs. old
1 11mos

ASSETS, LIABILITIES AND NETWORTH

(Including those of the spouse and unmarried children below eighteen (18)
years of age living in declarants household)
1. ASSETS
a.

Real Properties*

DESCRIPTION

KIND

(e.g. lot, house and

lot, condominium
and improvements)

(e.g. residential,
commercial, industrial,
agricultural and mixed
use)

N/A

N/A

LOCATION

ASSESSED

CURRENT

ACQUISITION

VALUE

FAIR MARKET
VALUE

(As found in the Tax Declaration of

Real Property)

N/A

N/A

N/A

YEAR

MODE

N/A

N/A

N/A

Subtotal:

b. Personal Properties*
DESCRIPTION

LAPTOP
DIGICAM
MOBILE PHONE

ACQUISITION COST

YEAR ACQUIRED

2012
2013
2013

N/A
ACQUISITION COST/AMOUNT

P 15,000.00
P 7,000.00
P 3,000.00
Subtotal : P 25,000.00
TOTAL ASSETS (a+b): P 25,000.00

2. LIABILITIES*
NATURE

SALARY LOAN
CONSOLOAN
MULTI PURPOSE LOAN

NAME OF CREDITORS

PHILIFE FINANCIAL CORP.

GSIS
PAGIBIG

OUTSTANDING BALANCE

P 85,000.00
P 80,000.00
P 25,000.00

TOTAL LIABILITIES: P 190,000.00

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NET WORTH : Total Assets less Total Liabilities = P 165,000.00

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

BUSINESS INTERESTS AND FINANCIAL CONNECTIONS

(of Declarant /Declarants spouse/ Unmarried Children Below Eighteen (18) years of Age Living in Declarants Household)

I/We do not have any business interest or financial connection.

NAME OF ENTITY/BUSINESS
ENTERPRISE

BUSINESS ADDRESS

NATURE OF BUSINESS
INTEREST &/OR FINANCIAL
CONNECTION

DATE OF ACQUISITION OF
INTEREST OR CONNECTION

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

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 aboveenumerated 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:

______________________________
GRACE M. VIERNES

N/A

(Signature of Declarant)

Government Issued ID:

ID No.:
Date Issued:

PRC
0762955
11/25/2013

(Signature of Co-Declarant/Spouse)
Government Issued ID:
ID No.:
Date Issued:

N/A
N/A
N/A

SUBSCRIBED AND SWORN to before me this 9th day of February 2015, affiant exhibiting to me the abovestated government issued identification card.

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_______________________________________
(Person Administering Oath)

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