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 , 2024__________
(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 EMOR CHACY JOY B. POSITION: TEACHER I
:
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPED-CADIZ CITY
ADDRESS: BLOCK 7 LOT 16 LENVIL HOMES BARANGAY SICABA OFFICE ADDRESS: ABELARDE ST. ZONE 3
CADIZ CITY NEGROS OCC. CADIZ CITY, NEGROS OCC.
SPOUSE: CAMELOTE KHARVEY JAY G. POSITION: N/A
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: N/A
OFFICE ADDRESS: N/A
N/A
UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S HOUSEHOLD
NAME DATE OF BIRTH AGE
N/A N/A N/A
N/A N/A N/A
N/A 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*
DESCRIPTIO KIND EXACT ASSESSED CURRENT FAIR ACQUISITION ACQUISITION
N (e.g. residential, LOCATION VALUE MARKET COST
commercial,
(e.g. lot, house and industrial, agricultural VALUE
lot, condominium and mixed use) (As found in the Tax Declaration of
and improvements)
Real Property)
YEAR MODE
N/A N/A N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A N/A N/A
Subtotal:
b. Personal Properties*
DESCRIPTION YEAR ACQUIRED ACQUISITION
COST/AMOUNT
REFRIGERATOR JANUARY 2024 P25, 000.00
ELECTRIC GAS STOVE FEBRUARY 2024 P5, 000.00
AIRCON INVERTER SPLIT TYPE AIR MAY 2024 P25, 000.00
TELEVISION JUNE 2024 P33, 000.00
HOT & COLD LAMINATING MACHINE JULY 2024 P2, 500.00
VEHICLE JULY 2024 P600, 000.00
PISO WIFI VENDO MACHINE SET AUGUST 2024 P10, 000.00
TABLE TOP OVEN SEPTEMBER 2024 P20, 000.00
STAND MIXER OCTOBER 2024 P5, 000.00
MINI DONUT MAKER OCTOBER 2024 P2, 500.00
CLOTHES & SHOES NOVEMBER 2024 P20, 000.00
CELLPHONE DECEMBER P15, 000.00
Subtotal : P763, 000.00
TOTAL ASSETS (a+b): P763, 000.00
* Additional sheet/s may be used, if necessary.
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2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING
BALANCE
SALARY LOAN NEGROS TEACHERS MPC SAGAY 800, 000.00
N/A N/A N/A
N/A N/A N/A
N/A N/A N/A
N/A N/A N/A
TOTAL LIABILITIES: 800, 000.00
NET WORTH : Total Assets less Total Liabilities = -P37,000.00
* 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 BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF
ENTITY/BUSINESS INTEREST &/OR FINANCIAL INTEREST OR CONNECTION
ENTERPRISE CONNECTION
N/A N/A N/A N/A
N/A N/A N/A N/A
N/A N/A N/A N/A
N/A N/A N/A N/A
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
N/A N/A N/A N/A
N/A N/A N/A N/A
N/A N/A N/A N/A
N/A N/A N/A N/A
N/A 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 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 15, 2025 _
N/A
(Signature of Declarant) (Signature of Co-Declarant/Spouse)
Government Issued ID: PRC ID Government Issued ID:
ID No.: 1321983 ID No.:
Date Issued: 11/14/2014 Date Issued:
SUBSCRIBED AND SWORN to before me this day of , affiant exhibiting to me the above-stated
government issued identification card.
_______________________________________
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(Person Administering Oath)
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