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 2020
(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: PAJE ARLENE B. POSITION: TEACHER III
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPEd RAWIS ELEMENTARY
ADDRESS: RAWIS BACON DISTRICT OFFICE ADDRESS: RAWIS BACON DIST.
SORSOGON CITY SORSOGON CITY
SPOUSE: PAJE RONALDO J. 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 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 VALUE CURRENT ACQUISITION ACQUISITION
(e.g. lot, house and (e.g. residential, LOCATION FAIR MARKET COST
lot, condominium commercial, industrial,
and improvements) agricultural and mixed use) VALUE
(As found in the Tax Declaration of
Real Property)
YEAR MODE
LOT RESIDENTIAL RAWIS 44,792.00 300,000.00 1998 OWNED 20,000.00
HOUSE RESIDENTIAL RAWIS 14,307.50 290,000.00 1998 OWNED 225,000.00
Subtotal: 245,000.00
b. Personal Properties*
DESCRIPTION YEAR ACQUIRED ACQUISITION
COST/AMOUNT
JEWELRY 2003 37,000.00
FURNITURE 2008-2019 150,000.00
APPLIANCES 2005/2020 52,000.00
BOOKS(ENCYCLOPEDIA) 2010 40,000.00
Subtotal : 279,000.00
TOTAL ASSETS (a+b): 524,000.00
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* Additional sheet/s may be used, if necessary.
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2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
CONSOLE LOAN GSIS 10,000.00
SALARY LOAN CITY SAVINGS 180,000.00
SALARY LOAN EAST WEST 100,000.00
PRIVATE LOAN 180,000.00
TOTAL LIABILITIES: 470,000.00
NET WORTH : Total Assets less Total Liabilities = 54,000.00
* 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
PAJE’S WOODWORKS RAWIS,BACON DIST.SOR FURNITURE MAKER 2017
CITY
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
ROASALINDA B.DERI SISTER TEACHER III SAN JUAN ELEMENTARY SCHOOL
BACON WEST DIST.SOR.CITY
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: ___02-17-2020___________________________
(Signature of Declarant) (Signature of Co-Declarant/Spouse)
Government Issued ID: PRC Government Issued ID:
ID No.: 0031606 ID No.:
Date Issued: 01-29-1997 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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