SWORN STATEMENT OF ASSETS, LIABILITIES, NET WORTH, DISCLOSURE OF BUSINESS INTERESTS AND FINANCIAL CONNECTIONS, AND IDENTIFICATION OF RELATIVES

IN THE GOVERNMENT SERVICE as of December 31, 2010

(Required by R. A. No.6713)
Name

FERRO,
Surname

ALEXIS
First Name

T.
M.I.

Posn./Gross Income

Pit Supervisor/394,547.06PHP

Phili ppine Am usem ent & Gam ing Corporation

Office Address LOT1,UNIT10 PAGCOR VILLAS FEMA ROAD, BAHAY TORO, QUEZON CITY Spouse

Office Address

1330 Roxas Boulevard, Ermit a, Manila

FER R O,
Surname First Name

C A RINA
M.I. Office

Position

R.

Unmarried children below 18 years of age

Name Date of Birth

NOT APPLICABLE

A. ASSETS, LIABILITIES AND NET WORTH 1. ASSETS a. Real Properties

Kind Location Nature of Property Year Mode of Acquired Acquisition (paraphernal conjugal or community) Assessed Value Current Fair Market Value Acquisition Cost Land, Bldg. Etc.
Improvements

RES. LOT TOWNHOUSE

DAVAO QUEZON

1989 LOAN 1990 LOAN

1Mphp 950T

TOTAL b. Personal and Other Properties

Kind

1,950,000PHP
Year Acquired Acquisition Cost

BOOKS APPLIANCES JEWELRIES CASH-ON-HAND

2009 2009 2009 2010

20,000PHP 30,000PHP 10,000PHP 10,000PHP

TOTAL 2. LIABILITIES (Loans, Mortgage, etc. )

Nature

70,000PHP
Amount

PAGCOR PROVIDENT LOAN CREDIT CARDS

500,000PHP 300,000PHP

TOTAL

800,000PHP

NET WORTH ( Total Assets {1a + 1b} Less Total Liabilities {2} ) = 1,220,000PHP
*Note: Instruction at the Back. Please use additional forms if necessary

PAGCOR HOUSE 1330 Roxas Boulevard Ermita Metro Manila ZIP Code 1000 Telephone (632) 521-1542 Connecting All Departments FAX (632) 522-2969

B. BUSINESS INTEREST AND FINANCIAL CONNECTIONS

Do you have any business interest and other financial connections including those of your spouse and unmarried children below 18 years of age living in your household ? ( ) yes ( XX ) no If yes give particulars; Name Name of Firm / Company Address Nature of Business Interest and/or Financial Connection Date of Acquisition or Connection

C. IDENTIFICATION OF RELATIVES IN THE GOVERNMENT SERVICE

To the best of your knowledge, are you related within the fourth degree of consanguinity or of affinity to anyone working in the government ? ( ) yes ( XX ) no If yes, give particulars; Name Position Relationship Name and Address of Office

I hereby certify to the best of my knowledge and information that these are true statements of my assets ,liabilities, net worth, business interest and financial connections, including those of my spouse and unmarried children below 18 years of age and names of my relatives in the government as of , , as required by and in accordance with Republic Act 6713.

I hereby authorized the Ombudsman or his 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 years of age living with me in my household covering previous years to include the year I first assumed office in the government.

Date :

MARCH 31, 2011

ALEXIS T. FERRO

Spouse's Signature over Printed Name

Employee's Signature over Printed Name

T.I.N. : Res. Cert. No. A : Issued At : Date Issued :

T.I.N. : Res. Cert. No. B : Issued At : Date Issued :

SUBSCRIBED AND SWORN TO before me this Residence Tax Certificate as indicated above.

day of

,20

_, affiant exhibiting his

(Person Administering Oath)

/hrd 02/2010