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 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 )