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

DECLARANT: LICONG JENNESSA V. POSITION: TEACHER-1

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPED CDO- BALULANG E.S.
ADDRESS: #023- PHASE 1 AREA 2, MACANHAN CARMEN OFFICE ADDRESS: BALULANG, CAG.DE ORO
CAG. DE ORO MISAMIS ORIENTAL CITY

SPOUSE: LICONG JUWILL M. POSITION: TEACHER-1

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPED CDO- BALUBAL NHS
OFFICE ADDRESS: BALUBAL, CAG.DE ORO
CITY

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

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

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

HOUSE RESIDENTI MACANHAN, 315,000 515,000 2019 CASH 515,000

AND LOT AL CARMEN, CAG.DE
ORO CITY

Subtotal: 515,000.00
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT

APPLIANCES 2019 50,000.00

GADGETS( 2 LAPTOPS, 4 CELLPHONES) 2019 91,000.00
MOTORCYLE 2018 104,000.00
ACCESSORIES 2018 20,000.00

Subtotal : Php 265,000.00

TOTAL ASSETS (a+b): Php 780,000.00

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

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2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

SALARY LOAN EASTWEST BANK Php 280,000.00

SALARY LOAN WEALTH BANK Php 413,000.00
SALARY LOAN GSIS Php 65,000.00

TOTAL LIABILITIES: Php 758,000.00

NET WORTH : Total Assets less Total Liabilities = Php 22,000.00
* 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

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
PETER PRIAM PAUL VERULA UNCLE TEACHER DEPED –CAGAYAN DE ORO CITY
MAY PSYCHE VERULA SISTER TEACHER DEPED –CAGAYAN DE ORO CITY
ANNA LEE D. FLORES AUNT TEACHER DEPED –CAGAYAN DE ORO 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: __________JANUARY 24, 2020____________________

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

Government Issued ID: DEPED ID Government Issued ID: PRC ID

ID No.: 4731313 ID No.: 1438275
Date Issued: JULY 20,2019 Date Issued: FEB.13, 2016

SUBSCRIBED AND SWORN to before me this 24TH day of JANUARY 2020, affiant exhibiting to me the
above-stated government issued identification card.

_______________________________________
(Person Administering Oath)

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