Revised as of January 2015

Per CSC Resolution No. 1500088

Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH

As of DECEMBER, 2018
(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: IMAM, DATU NASHRULLAH A. POSITION: PROVINCIAL BOARD MEMBER

(Family Name) (First Name) (M.I.)
AGENCY/OFFICE: OFFICE OF THE SANGGUNIANG
UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S HOUSEHOLD
PANLALAWIGAN
ADDRESS: BUGASAN MATANOG,
NORTE, NAME DATE OF
OFFICE BIRTH
ADDRESS: AGE
BULUAN, MAGUINDANAO
IMAM, BAI NASHRIEN SINSUAT 03/ 22/ 2002 17
IMAM,MAGUINDANAO
DATU NASHRULLAH JR. SINSUAT 07/ 24/ 2003 16
IMAM, DATU NASHAKIF SINSUAT 04/26/ 2008 10
SPOUSE: IMAM, BAI ERIN S. POSITION:
IMAM, DATU NASHEMIR SINSUAT 04/10/2010 8
(Family Name) (First Name) (M.I.) AGENCY/OFFICE:
IMAM, BAI NASHMINAH VALE 01/ 30/ 2011
OFFICE ADDRESS:
7

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

N/A N/A N/A N/A N/A N/A N/A N/A

Subtotal:
b. Personal Properties*
DESCRIPTION YEAR ACQUIRED ACQUISITION
COST/AMOUNT

JEWELRIES AND CLOTHES 2001-2018 970, 000.00

OLYMPIC ARMS AND GLOCK 2003 AND 2005 320, 000.00
FI5O 2007 850, 000.00
MONEY IN BANK (LBP) 2013-2018 1,000,000.00
MONEY IN BANK (BDO) 2017-2018 500, 000.00
BICYCLES 2017-2018 180, 000.00
GADGETS 2018 195, 000.00

Subtotal :
TOTAL ASSETS (a+b):
* Additional sheet/s may be used, if necessary.

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2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

MULTI- PURPOSE LOAN PAG-IBIG 75, 000.00

CONSOL LOAN GSIS 350, 000.00
SALARY LOAN LANDBANK OF THE PHIL. (BULUAN) 116, 244. 33

TOTAL LIABILITIES:
NET WORTH : Total Assets less Total Liabilities =
* 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
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
DATU LESTER S. SINSUAT UNCLE VICE GOVERNOR PROVINCIAL GOVERNMENT OF MAGUINDANAO

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: ______________________________

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

Government Issued ID: Government Issued ID:

ID No.: ID No.:
Date Issued: 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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