SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH

As of DECEMBER 2015
(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: MEDIAVILLA MELISSA C. POSITION: TEACHER I

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: P.D. MONFORT NSHS
ADDRESS: P.D. MONFORT DUMANGAS , ILOILO OFFICE ADDRESS: P.D. MONFORT SOUTH
NORTH
DUMANGAS, ILOILO
SPOUSE: MEDIAVILLA JOSEPH C. POSITION: N/A
(Family Name) (First Name) (M.I.) AGENCY/OFFICE:
OFFICE ADDRESS:

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

NAME DATE OF BIRTH AGE

JOLISSA MAE C. MEDIAVILLA MAY 8, 2003 12
JAN MARK C. MEDIAVILLA JANUARY 7, 2005 10
JARIL MILES C. MEDIAVILLA APRIL 26, 2006 9
JESSE MIEL C. MEDIAVILLA MAY 3, 2009 6

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 LOCATION ASSESSED CURRENT FAIR ACQUISITION ACQUISITION COST

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

HOUSE P.D. MONFORT

RESIDENTIAL 2013-2014 INSTALLMENT 240,000.00
IMPROVEMENT NORTH

Subtotal: P240,000.00
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION COST/AMOUNT

APPLIANCES 2010-2013 25,000.00

NETBOOK, PRINTER AND GADGETS 2011-2014 25,000.00
BOOKS 2010-2011 15,000.00

Subtotal: P65,000.00
TOTAL ASSETS (a+b) P305,000.00
2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

EMERGENCY LOAN GSIS 40,000.00

EDUCTIONAL LOAN GSIS 4,000.00
BANK LOAN CSB 200,000.00
PRIVATE LOAN PRIVATE PERSON 70,000.00
TOTAL LIABILITIES: P294,000.00

NET WORTH : Total Assets less Total Liabilities = P11,000.00

Page 1 of 2
* 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 BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF INTEREST

ENTITY/BUSINESS INTEREST &/OR FINANCIAL
ENTERPRISE CONNECTION
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

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.

MARCH 7, 2016
Date: ______________________________

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

Government Issued ID: BUREAU OF INTERNAL REVENUE Government Issued ID:

ID No.: 941-072-164 ID No.:
Date Issued: 01-14-08 Date Issued:

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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 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 Not Applicable

DECLARANT: PANES LYNNARD PHILIP L POSITION: SENIOR BOOKKEEPER I

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: P.D. MONFORT NSHS
ADDRESS: 02-057 F. PALMARES ST., OFFICE ADDRESS: P.D. MONFORT SOUTH
PASSI CITY ILOILO DUMANGAS, ILOILO

SPOUSE: N/A POSITION: N/A

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

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

NAME DATE OF BIRTH AGE

N/A N/A N/A

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 LOCATION ASSESSED CURRENT FAIR ACQUISITION ACQUISITION COST

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

N/A

Subtotal: 0.00
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION COST/AMOUNT

ELECTRONIC GADGETS 2011-2013 47,500

CLOTHING APPARELS 2011-2013 30,000
CASH IN BANK 2011-2013 80,000

Subtotal : 157,500.00
TOTAL ASSETS (a+b): 157,500.00
3. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

SALARY LOAN CITY SAVINGS BANK 134,574.20

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 TOTAL LIABILITIES: 134,574.20

NET WORTH : Total Assets less Total Liabilities = 22,925.80

* 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 BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF INTEREST

ENTITY/BUSINESS INTEREST &/OR FINANCIAL
ENTERPRISE CONNECTION
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

JOCELYN L PANES MOTHER Admin. Officer I PASSI NATIONAL HIGH SCHOOL

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.

APRIL 15, 2015

Date: ______________________________

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

Government Issued ID: GSIS ECARD PLUS 2 Government Issued ID:

ID No.: 02004173701 ID No.:
Date Issued: 2012 Date Issued:

SUBSCRIBED AND SWORN to before me this day of , affiant exhibiting to me the above-stated
government issued identification card.

_______________________________________
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(Person Administering Oath)

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