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, 2017
(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: ARNAIZ CHERRY LYN D. POSITION: Teacher 1
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DepED – Laguna
ADDRESS: San Antonio Kalayaan, Laguna OFFICE ADDRESS: Malaking Ambling Magdalena , Laguna
SPOUSE: ARNAIZ BARRY V. POSITION: DRIVER
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: TREVI PHILIPPINE FOUNDATION
OFFICE ADDRESS: SUCAT PARAÑAQUE
UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S HOUSEHOLD
NAME DATE OF BIRTH AGE
ANJA LUIZ D. ARNAIZ OCTOBER 31, 2007 10 yrs/o
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
Subtotal:
b. Personal Properties*
DESCRIPTION YEAR ACQUIRED ACQUISITION
COST/AMOUNT
Gadgets (Cellphone,tablets,laptop,printer) 2014-2017 75,000.00
Appliances(t.v, speacker, component, ref) 2014-2017 50,000.00
Home Furnitures 2015-2017 30,000.00
Vehicle(Toyota corolla,barako motorcycle) 2016-2017 170,000.00
Subtotal : 325,000.00
TOTAL ASSETS 325,000.00
(a+b):
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
Loan GSIS- CONSUL 50,000.00
Loan CITY SAVINGS 250,000.00
TOTAL LIABILITIES: 300,000.00
NET WORTH : Total Assets less Total Liabilities = 25,000.00
* Additional sheet/s may be used, if necessary.
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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 INTEREST &/OR DATE OF ACQUISITION OF INTEREST
ENTERPRISE FINANCIAL CONNECTION OR CONNECTION
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
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: ______________________________
CHERRY LYN D. ARNAIZ
(Signature of Declarant) (Signature of Co-Declarant/Spouse)
Government Issued ID: PRC- LICENSE Government Issued ID:
ID No.: 1235041 ID No.:
Date Issued: 12/3/2013 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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