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Revised 2013
SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH
As of ________________________________
(Sample additional sheet/s for the exclusive properties of the declarants spouse and unmarried children
below eighteen (18) years of age living in declarants household)
NAME: POSITION:
(Family Name) (First Name) (M.I.) AGENCY/OFFICE:
1. ASSETS
a. Real Properties
b. Personal Properties
2. LIABILITIES
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SALN
Revised 2013
NAME: POSITION:
(Family Name) (First Name) (M.I.) AGENCY/OFFICE:
1. ASSETS
a. Real Properties
Subtotal:
b. Personal Properties
Subtotal :
TOTAL ASSETS (a+b):
2. LIABILITIES
TOTAL LIABILITIES:
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