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 July 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
DECLARANT: NAVARRO BERYL JOY A. POSITION: TEACHER 2
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DepEd/ SAN MIGUEL I
ADDRESS: OFFICE ADDRESS:
POBLACION, SAN MIGUEL, SDS
P-2, TINA SAN MIGUEL, SdS
SPOUSE: NONE NONE NONE POSITION: NONE
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: NONE
OFFICE ADDRESS: NONE
UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S HOUSEHOLD
NAME DATE OF BIRTH AGE
NONE NONE NONE
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
VALUE MARKET VALUE COST
(e.g. lot, house and (e.g. residential,
lot, condominium commercial, industrial,
LOCATION
and improvements) agricultural and mixed
use) (As found in the Tax Declaration of
YEAR MODE
Real Property)
N/A N/A N/A N/A N/A
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Subtotal: N/A
b. Personal Properties*
DESCRIPTION YEAR ACQUIRED ACQUISITION
COST/AMOUNT
CELLPHONE 2018 8,000.00
CLOTHING 2018 2,000.00
Subtotal : 10,000.00
TOTAL ASSETS (a+b): 10,000.00
* Additional sheet/s may be used, if necessary.
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
N/A N/A N/A
TOTAL LIABILITIES:
NET WORTH : Total Assets less Total Liabilities = 10,000.00
* 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
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(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
ALLYN A. DUMANACAL COUSIN TEACHER-1 DepEd /SMNCHS MAIN- MAGROYONG, SAN MIGUEL,
SURIGAO DEL SUR
CLEAR N. AMPIS COUSIN TEACHER-1 DepEd/ BACACAAN ESLT- SAN MIGUEL, SURIGAO
DEL SUR
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: PRC ID Government Issued ID:
ID No.: 1714335 ID No.:
Date Issued: JANUARY 10, 2019 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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