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 31, 2021
(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: Vicencio, Vilma Q. POSITION: Teacher 1

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: Sampaguita High School
ADDRESS: Blk. 24 Lot.1, Kasmo St., St. Therese, Deca Homes, OFFICE ADDRESS: # 11 Paraiso Sampaguita St.,
Loma de Gato, Marilao, Bulacan
Camarin, Caloocan City

SPOUSE: Vicencio Manuelito A. POSITION: N/A

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: N/A
OFFICE ADDRESS: 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
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*

DESCRIPTION KIND EXACT ASSESSED CURRENT FAIR ACQUISITION ACQUISITION

(e.g. lot, house and (e.g. residential, LOCATION VALUE MARKET VALUE COST
lot, condominium commercial, industrial,
(As found in the Tax Declaration of
and improvements) agricultural and mixed YEAR MODE
use) Real Property)

House & Residential Blk.24,Lot 1 283,730 853,425,40 2006 Install 1,800,000.00

Lot St. Therese Deca ment
Homes, LDG,
Marilao,Bulacan

Memorial Memorial OLEP, Muzon San 30,000 40,000 2011 Install 45,000.00
Lot Lot Jose Del Monte, ment
Bulacan

Memorial Memorial OLEP, Muzon, 35,000 45,000 2012 Install 50,000.00

Lot Lot San Jose Del ment
Monte, Bulacan
Lot Lot
Subtotal: 1,895,000.00

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT

Iphone 2016 15,000.00

Canon printer 2015 2,700.00
Clothing and personal belongings Various Years 50,000.00
Laptop 2021 20,000.00
Subtotal : P 67,700.00

TOTAL ASSETS (a+b): P 1,962,700.00

* Additional sheet/s may be used, if necessary.

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2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

TOTAL LIABILITIES: P - 5,000. 00

NET WORTH : Total Assets less Total Liabilities = P 1,957,700.00
* 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 ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF

ENTERPRISE INTEREST &/OR FINANCIAL INTEREST OR CONNECTION
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 21, 2021

(Signature of Declarant) (Signature of Co-Declarant/Spouse)

Government Issued ID: PRC Government Issued ID: PASSPORT

ID No.: 1422410 ID No.: 8074540A
Date Issued: DECEMBER 28, 2015 Date Issued: 25 JULY 2018

SUBSCRIBED AND SWORN to before me this 21st day of JANUARY 2021, affiant exhibiting to me the
above-stated government issued Identification card.

GINALYN B. DIGNOS, Ed.D

Principal IV
(Person Administering Oath)

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