SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH

As of December 31, 2014

(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
DECLARANT
:
ADDRESS:

Separate Filing

CALULOT

ALEXANDER

D.

(Family Name)

(First Name)

(M.I.)

Homestead,

Bambang,

Not Applicable
Sangguniang Bayan Member

POSITION:
AGENCY/OFFICE:

Municipal Government of Bambang

OFFICE ADDRESS:

Buag, Bambang, Nueva Vizcaya

Nueva Vizcaya
SPOUSE:

CALULOT

IMEE ANDRE

R.

(Family Name)

(First Name)

(M.I.)

POSITION:
AGENCY/OFFICE:
OFFICE ADDRESS:

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANTS HOUSEHOLD
NAME

DATE OF BIRTH

ALEXANDER R. CALULOT III

ALEXIEL TIMOTHY ZANDER R. CALULOT

AGE

May 23, 2005

April 7, 2008

9
7

ASSETS, LIABILITIES AND NETWORTH

(Including those of the spouse and unmarried children below eighteen (18)
years of age living in declarants household)
1. ASSETS
a.

Real Properties*

DESCRIPTION

KIND

(e.g. lot, house and

lot, condominium
and improvements)

(e.g. residential,
commercial, industrial,
agricultural and mixed
use)

LOCATION

ASSESSED

CURRENT FAIR

VALUE

MARKET VALUE

(As found in the Tax Declaration of

Real Property)

ACQUISITION
YEAR

ACQUISITION COST

MODE

Subtotal:

b. Personal Properties*
DESCRIPTION

YEAR ACQUIRED

Isuzu Trooper
Appliances
Personal Belongings

2012
2011-2014
2010-2014

ACQUISITION COST/AMOUNT

P450, 000.00
P100, 000.00
P55, 000.00

Subtotal :
TOTAL ASSETS (a+b): P605,000.00
2. LIABILITIES*
NATURE

Consolidated/Policy/Emergency/
Educational Loan
Multi-purpose/Calamity Loan

NAME OF CREDITORS

OUTSTANDING BALANCE

GSIS

P145,000.00

HDMF

P78, 000.00

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TOTAL LIABILITIES: P223,000.00

NET WORTH : Total Assets less Total Liabilities = P382,000.00
* Additional sheet/s may be used, if necessary.

BUSINESS INTERESTS AND FINANCIAL CONNECTIONS

(of Declarant /Declarants spouse/ Unmarried Children Below Eighteen (18) years of Age Living in Declarants Household)

I/We do not have any business interest or financial connection.

NAME OF ENTITY/BUSINESS
ENTERPRISE

BUSINESS ADDRESS

NATURE OF BUSINESS
INTEREST &/OR FINANCIAL
CONNECTION

DATE OF ACQUISITION OF
INTEREST OR CONNECTION

GIMMERS CHILL BAR

Homestead, Bambang, N. V.

Bar & Restaurant

2010

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

ATTY. ALEXANDER A. CALULOT

Father

Register of Deeds

Registry of Deeds- Nueva Vizcaya

MARINELLE M. CALULOT

Sister-in-Law

Clerk of Court

Municipal Trial Court - Bambang

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 aboveenumerated 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:

March 12, 2015

(Signature of Declarant)
Government Issued ID:
ID No.:
Date Issued:

(Signature of Co-Declarant/Spouse)

BIR - TIN
943-650-024

Government Issued ID:

ID No.:
Date Issued:

SUBSCRIBED AND SWORN to before me this

government issued identification card.

day of

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BIR - TIN
263-054-099

, affiant exhibiting to me the above-stated

_______________________________________
(Person Administering Oath)

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