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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 31, 2019
(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
KRI
DECLARANT: LAPITAN KRISTHEL B. POSITION: TEACHER I
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPED/ LILIW NHS
ADDRESS: 172 MABINI ST. BRGY. MASIKAP, LILIW, LAGUNA OFFICE ADDRESS: G M EVASCO ROAD BRGY.
KANLURANG BUKAL, LILIW, LAGUNA

SPOUSE: N/A N/A N/A POSITION: N/A


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

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S 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 declarant’s household)
1. ASSETS
a. Real Properties*

DESCRIPTION KIND EXACT ASSESSED CURRENT FAIR ACQUISITION ACQUISITION COST


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

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

Subtotal: 0.00
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION


COST/AMOUNT

FURNITURES 2019 P 17, 500.00


CLOTHES, FOOTWEAR, BAGS, OTHER APPAREL 2017-2019 P 35, 000.00
LAPTOP 2018 P 24, 000.00
EPSON PRINTER, NETBOOK, CELLULAR PHONE 2015 P 92, 190.00
Subtotal : P168, 690.00
TOTAL ASSETS (a+b): P168, 690.00
2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

SALARY LOAN AMA BANK P350,000.00

TOTAL LIABILITIES: P 350,000.00


NET WORTH : Total Assets less Total Liabilities = -P 181,310.00

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

BUSINESS INTERESTS AND FINANCIAL CONNECTIONS

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(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.
KRIS

NAME OF ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS INTEREST &/OR DATE OF ACQUISITION OF INTEREST
ENTERPRISE FINANCIAL CONNECTION 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


NIEL B. BUENASEDA COUSIN TEACHER III DEPED CALUMPANG NHS

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: _____________________

KRISTHEL B. LAPITAN N/A


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

Government Issued ID: PRC Government Issued ID: N/A


ID No.: 1240225 ID No.: N/A
Date Issued: 12/09/13 Date Issued: N/A

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

KRISTINE P. PEREZ
_______________________________________
Principal I
(Person Administering Oath)

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