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STATEMENT OF ASSETS , LIABILITIES AND NET WORTH AND DISCLOSURE OF BUSINESS INTEREST , FINANCIAL CONNECTIONS AND RELATIVES IN THE GOVERNMENT SERVICE As of December 31 , 2011 ( Required by R.A. No. 3019 and 6713 ) ( Note : Husband

and Wife who are both public officials or employees may  file the required statements statements jointly or separately separately ) Jointly Filed

 Name :

GALDIANO ALLAN JOTOJOT ( Surname ) ( First Name ) ( Middle Name ) Purok-3 , La Suerte . Prosperidad , Agusan del Sur

Address :

I am married Spouse :

NO. 1 2 3 4 5 6

Separately Filed

GALDIANO ( Surname )

Position : TEACHER - I Office : Dep. Ed Office Address : Government , Center Patin-ay , Prosperidad , Agusan Sur

I am not married GINA ( First Name )

GUMATA ( Middle Name )

Position : NONE Office : NONE Office Address: NONE

Unmarried children below 18 years of age living in his / her household: NAME VICAN LEN G. GALDIANO

DATE OF BIRTH OCTOBER 09, 2009

I have no children below 18 years of age living in my household ASSETS , LIABILITIES AND NET WORTH I  –  ASSETS  ASSETS ( Including that

of declarant’s spouse and unmarried children below 18 years of age living in his/her

hosehold ) A . REAL PROPERTY/ PROPERTY/ IES ( KIND ( Res./Comm./ Agri.etc.)

 NONE  NONE

NATURE OF PROPERTY (paraphernal ,conjugal or community ) NONE  NONE 

Use additional sheet/s if necessary ) ACQUISITION LOCATION

ASSESSED VALUE 

MODE  NONE   NONE 

 NONE   NONE 

YEAR  NONE   NONE   NONE   NONE 

 NONE   NONE  TOTAL

B. PERSONAL PROPERTY/ IES AND OTHER ASSETS ( Use additional sheet/s ACQUISITION TANGIBLE MODE YEAR APPLIANCE Purchased 2011 CPU SYSTEM Purchased 2011

INTANGIBLE BANK DEPOSITS GSIS Phil Health PAG-IBIG Fund

Savings Personal Share Personal Share Personal Share

FAIR MARKET VALUE 

ACQUISITION COST

Land,Bldg Others  NONE   NONE 

Improve ment  NONE   NONE 

if necessary )   ACQUISITION COST 20,000 20,000

Until Retireme Retirement nt Until Retireme Retirement nt Until Retireme Retirement nt

55,000 18,456 2,100 1,200

TOTAL

116,756.00

For computation Purposes ,use acquisition cost, Properties of unmarried children below 18 years of age living his/her household shall be excluded as well as the parapheral / exclusive properties of spouse , in case of separate filing. TOTAL ASSETS ( A + B ) = 116,756. 116,756.00 00 II  –  LIABILITIES  LIABILITIES ( Including

that of declarant’s spouse and unmarried children below 18 years of age living in his / her household  ) )

NATURE SALARY LOAN

NAME OF CREDITORS NETWORK BANK

OUTSTANDING BALANCE 76,100.00

TOTAL

76,100.00

In the computation of outstanding balance , properties of unmarried children below 18 years of age living in his / her household shall be excluded as well as the paraphernal / exclusive properties of spouse , in case of separate filing.

 

TOTAL ASSETS A + B ) LESS TOTAL LIABILITIES LIABILITIES  III  –  NET WORTH ( TOTAL



TOTAL NET WORTH

NATURE Basic Salary ACA / PERA Clothing Productivity Mid Year Bonus Year End Bonus Performance Incentives Bonus

116,756.00  76,100.00 40,656.00

AMOUNT AND SOURCES OF GROSS INCOME ( All amounts received from all sources for the preceding calendar year ) SOURCES Dep. Ed Dep. Ed Dep. Ed Dep.Ed Dep.Ed Dep.Ed Dep. Ed

AMOUNT 119,693.00 24,000.00 4,000.00 2,000.00 11,045.00 11,045.00 10,000.00

TOTAL

165,783.00

AMOUNT OF PERSONAL AND FAMILY EXPENSES ( EXPENSES ( For the preceding calendar year ) PERSONAL EXPENSES ESTIMATED AMOUNT FAMILY EXPENSES ESTIMATED AMOUNT Food 54,750 Food 70,000 Medicine 2,000 Electric Bill 6,000 Transportation 500 Recreation 8,000 Communication 1,000 Cosmetics 5,000 Haircut 360 Clothing 3,000 Medicine 8,000

TOTAL

58,610.00 AMOUNT OF INCOME TAXES PAID ( For NATURE

TOTAL

100,000.00

the preceding p receding calendar year   )) AMOUNT 18,466.00 0

Compensation Business Others TOTAL

18,466.00 

BUSINESS INTEREST AND FINANCIAL CONNECTIONS

Declarant/Spouse/Unmarried se/Unmarried children below 18 years of age living in the household of declarant) ( Declarant/Spou I / we don’t have any business business interest and financial connections Nature of Business Interest Date of Acquisition of Name of Entity/Business Enterprise Business Address and/or Financial Connection Interest of connection  None  None None None I

RELATIVE/S IN THE GOVERNMENT th 

( Up Ito Ithe 4  civil degree of relationship , either by consanguinity or affinity , including billas,inso and balae ) / we don’t know of any relatives/s in the government government   Name of Relative Duriza G. Alvar

Relationship Auntie

Position Teacher-I

Name of Office / Address Mapaga Elem. School

I / We hereby certify that these are my / our true and detailed Assets , Net worth ,Amount and Sources of income ,Personal family Expenses ,Amount ,Am ount of Income Taxes Paid ,Business Interest and financial connection ,including those of my spouse and my/our below 18 years of age living in my household ,and in the name/s of my relative/s in the government , as of December 31, 2011 as required by and accordance with Republic Act No.3019 and 6713. I / We hereby authorize the Ombudsman or his duly authorized representative to obtain and secure from all appropriate agencies, including the Bureau of Internal revenue, such documents that may show such Asset, Liabilities, Net worth, Business Interest and Financial connection including those of my spouse and my / our below 18 years of age living in my household , covering previous years and if possible ,including the year I / We first assumed office of the government. I / We further undertake to produce all supporting documents for each of the entries herein made when required.

Declarant/s Signature: ALLAN J. GALDIANO Date: March 22, 2012

Spouse:  Spouse:  Date:

( For separate Filing ) Spouse Signature: GINA G. GALDIANO Date: March 22, 2012  TH

SUBCRIBED AND SWORN TO before me on this 24   day of February 2012 , affiant(s) exhibiting his / her / their Tax Identification Number(s) 201109214067 and Employee Number(s) 4236272 .

ANDRESA G. ENRIQUEZ , AO - III ( Person Administering Oath )

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