SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH

As of DECEMBER 31, 2018

(Required by RA. 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: _ SAGURAN, HONELYN R. _ POSITION: SECONDARY SCHOOL_TEACHER –I_

(Family Name) (First Name) (M.I.) AGENCY ADDRESS: DEPED, DIVISION OF OZAMIZ CITY_
ADDRESS: PRK. 3, LIPOSONG, OZAMIZ CITY _ OFFICE ADDRESS: IBJT AGORA, CARANGAN, OZAMIZ CITY
____________________ _____________________________

SPOUSE: SAGURAN, JOSE JR. B POSITION: ___________________________

(Family Name) (First Name) (M.I.) AGENCY ADDRESS: __________________________
OFFICE ADDRESS: __________________________
___________________________

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S HOUSEHOLD

NAME DATE OF BIRTH AGE

___ __ HERSHEY NICOLE RODRIGUEZ __APRIL 19, 2013_________ _ 5 YRS, OLD_____
FITS ZIAN R. SAGURAN________ __NOVEMBER 22, 2014______ __ _ 4 YRS. OLD____
_________ NONE______________ ___ _ N/A______________ ____ N/A__________
________ _____ 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 LOCATION ASSESSED CURRENT FAIR ACQUISITION ACQUISITION COST
(e.g. lot, house and (e.g. residential, VALUE MARKET
lot colonialism commercial, VALUE
and improvements) industrial,
agricultural and
missed use)
(As found in the Tax Declaration YEAR MODE
of Real Property)
NONE N/A N/A N/A N/A N/A N/A N/A
NONE N/A N/A N/A N/A N/A N/A N/A
NONE N/A N/A N/A N/A N/A N/A N/A

NONE N/A N/A N/A N/A N/A N/A N/A

Subtotal: _N/A________
b.Personal Properties*
DESCRIPTION YEAR ACQUIRED ACQUISITION COST/AMOUNT
CLOTHING 2018 Php. 5,000.00
CELLPHONE 2018 17, 990.00
APPLIANCES 2018 15,000.00
LAPTOP 2018 22,000.00
NONE N/A N/A
Subtotal: ______59, 990.00
TOTAL ASSETS (a+b): Php. 59, 990.00
2.LIABILITIES*.
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
NONE N/A N/A
NONE N/A N/A
NONE N/A N/A
NONE N/A N/A
TOTAL LIABILITIES: Php. ______________
NET WORTH: Total Assets less Total Liabilities=___________________

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

Page 1 0f ____
 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
NONE N/A N/A N/A
NONE N/A N/A N/A
NONE N/A N/A N/A
NONE N/A N/A N/A

RELATIVES IN THE GOVERNMENT SERVICE

(Within the Fourth Degree of Consanguinity or Affinity, Include also Bilas, Bale 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

ROSE B. CABEZAS AUNT TEACHER DEP.ED – ZAMBOANGA DEL SUR
RONILO B. DAULONG COUSIN TEACHER DEP.ED – ZAMBOANGA DEL SUR
NONE N/A N/A N/A
NONE N/A N/A N/A
NONE N/A N/A N/A

I hereby certify that these are true and correct statements of my assets, liabilities, net worth,
business interests and financial connections, including those of any 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 interest and financial connections, to include those of
my spouse and unmarried children below 18 year of age living with me in my household covering previous
years to include the year I first assumed office in government.

Date: JANUARY 22, 2018

HONELYN R. SAGURAN_____ _________ N/A_____________

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

Government Issued ID. PRC___________________ Government Issued ID. ___ N/A______

ID. No: 1534389 ___ ID. No: ____ N/A______
Date Issued: 05-29-2017____________ Date Issued: ____ N/A______

SUBSCRIBED AND SWORN to before me this___ day of ____ affiant exhibiting to me the above-stated
government issued identification card.

__________________________________
(Person Administering Oath)