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, 2017
(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: SAGUSAY SUEDA O POSITION: RHE PNCO / SPO3
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: PNP HOSPITAL REGION
13
ADDRESS: P2, PATINAY, PROSPERIDAD, AGUSAN OFFICE ADDRESS: CAMP RAFAEL
DEL SUR RODRIGUEZ
LIBERTAD BUTUAN CITY

SPOUSE: SAGUSAY AUGUSTINE B POSITION: UTILITY WORKER

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DOMPH
OFFICE ADDRESS: PATIN AY PADS

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S

HOUSEHOLD

NAME DATE OF BIRTH AGE

SHAND AUSTIENE O SAGUSAY AUGUST 26,1995 13 YRS OLD

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
2.

a. Real Properties*

DESCRIPTION KIND EXACT ASSESS CURRENT ACQUISITION ACQUISITION

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

House Squatter Patin-ay N/A N/A 1995 Cash 310,000.00

Lot Area PADS 2018

Subtotal: 310,000.00

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT

Gadgets 2011-2016 130,000.00

Jewelries 2010-2016 75,000.00
Appliances 2010-2016 300,000.00
Subtotal : 505,000.00
TOTAL ASSETS (a+b): 815,000.00
Page 1 of ___
* Additional sheet/s may be used, if necessary.
2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

SALARY LOAN AFPSLAI 565,000.00

SALARY LOAN PSSLAI 325,000.00
POLICY LOAN PSMBFI 60,000.00
950,000.00
NET WORTH : Total Assets less Total Liabilities = 135,000.00
* 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

ENTITY/BUSINESS INTEREST &/OR FINANCIAL OF INTEREST OR
ENTERPRISE CONNECTION CONNECTION
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
PENNY JO LIMOT SISTER TEACHER ENHS - EADS
HAZEL S OSANO SISTER CLERK DRH TAGUM CITY

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: _ FEBRUARY 12, 2018__

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

Government Issued ID: PNP ID Government Issued ID: GOV’T ID

ID No.: 17K220089 ID No.: 0889
Date Issued: 11-22-2017 Date Issued: 06-14-2016

SUBSCRIBED AND SWORN to before me this 12th day of February 2018, affiant exhibiting to me
the above-stated government issued identification card.

PSUPT SHIRLEY O ESTRADA

(Person Administering Oath)
Page 2 of ___
 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, 2017
(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: PALMA RITCHE LOU B. POSITION: CHIEF MEDICAL DISPENSARY
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: PHILIPPINE NATIONAL POLICE
ADDRESS: 57 CUSTODIO ST, CENTRAL, PLACER, SURIGAO OFFICE ADDRESS: CAMP QUINTIN MERECIDO
DEL NORTE HOSPITAL, CATITIPAN, DAVAO
CITY

SPOUSE: PALMA CLARITA J. POSITION: HOUSEWIFE/ BUSINESSWOMAN

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: RC LOGIC SOLUTIONS
OFFICE ADDRESS: AGRO BLDG., PLACER, SURIGAO
DEL NORTE

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S

HOUSEHOLD

NAME DATE OF BIRTH AGE

IAN KIRK LOUISE PALMA JULY 15,2003 14Y/O
RITCH IVAN PALMA SEPTEMBER 25,2004 12Y/O
IAN KHYNDRIC PALMA NOVEMBER 17,2000 16Y/O

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 ACQUISITION ACQUISITION

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

FARM/ AGRI AGRICULTURAL TUBAJON, DINAGAT 300, 000 1,000,000 1999 DONATION 400,000.00
ISLAND
RESIDENTIAL RESIDENTIAL TUBAJON, DINAGAT 250,000 900,000 1999 DONATION 350,000
LOT ISLAND
HOUSE AND RESIDENTIAL BUTUAN CITY 1,250,000 1,900,000 2008 PAG IBIG 1,500,000
LOT
RESIDENTIAL RESIDENTIAL SURIGAO CITY 300,000 900,000 1999 DONATION 400,000
LOT
LOT RESIDENTIAL SAMAL, DAVAO 200,000 200,000 2016 LOAN 200,000
Subtotal: 2,850,000
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT

NISSAN SENTRA SEDAN 2000 280,000.00

MOTORCYCLES/BIKES 2003-PRESENT 700,000.00

Page 3 of ___
JEWELRIES 1996-2016 600,000.00
APPLIANCES AND FURNITURES 1997-2016 1,200,000.00
TOYOTA VIOS SEDAN 2016 730,000.00
NISSAN NAVARA 2017 1,300,000.00

Subtotal : 4,710,000.00
TOTAL ASSETS (a+b): 7,660,000.00
* Additional sheet/s may be used, if necessary.

3. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

HOUSING LOAN PAG IBIG 800,000.00

EMERGENCY LOAN SSLAI 200,000.00
AUTO LOAN TFS INC., UCPB 1,000,000.00
2,000,000.00
NET WORTH : Total Assets less Total Liabilities = 5,660,000.00
* 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

ENTITY/BUSINESS INTEREST &/OR FINANCIAL OF INTEREST OR
ENTERPRISE CONNECTION CONNECTION
RC LOGIC SOLUTIONS O4 AGRO BLDG., PLACER, IT CONSULTANCY MAY 4, 2010
SURIGAO DEL NORTE IT PROVIDER

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. EVANGELINE YAP AUNT SENIOR LEGAL DEPARTMENT OF JUSTICE
ATTY. RODALYN YAP COUSIN CHIEF, LGOO DILG
ATTY. GRACIANO COMPE COUSIN RTC JUDGE SUPREME COURT OF THE PHILIPPINES
DIR. LUNINGNING JADULCO AUNT DIRECTOR III DEPARTMENT OF FINANCE
DR. RHODORA LAPUZ COUSIN CHIEF DEPARTMENT OF HEALTH
RESEARCH
DR. HERNANDO PALMA COUSIN ASST. ADMIN UNIVERSITY OF THE PHILIPPINES DILIMAN
ENGR. JUNIFER REYES COUSIN PROVINCIAL PROVINCE OF DINAGAT ISLAND
ENGR.

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.

Page 4 of ___
 Date: _ FEBRUARY 15, 2018__

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

Government Issued ID: PNP ID Government Issued ID: CTC

ID No.: 13E090054 ID No.: 08477435
Date Issued: 2/13/2016 Date Issued: JAN. 25, 2018

SUBSCRIBED AND SWORN to before me this 15th day of February 2018, affiant exhibiting to me
the above-stated government issued identification card.

PSUPT SHIRLEY O ESTRADA

(Person Administering Oath)

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, 2017
(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: MEDRANO MICHAEL T. POSITION: GENERAL DUTY NURSE
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: PHILIPPINE NATIONAL POLICE
ADDRESS: 7 ST., GUINGONA SUBD., JP RIZAL, BUTUAN CITY OFFICE ADDRESS: LIBERTAD, BUTUAN CITY

SPOUSE: OLVIDA MARIA FE C. POSITION: DECEASED

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

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S

HOUSEHOLD

NAME DATE OF BIRTH AGE

MIKAELA NINA OLVIDA MEDRANO SEPTEMBER 28, 2006 11Y/O

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 ACQUISITION ACQUISITION

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

N/A

Page 5 of ___
 Subtotal:

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT

HOUSE AND FURNITURE REPAIR 2017 63,000.00

HONDA WAVE R 100 2007-2017 43,000.00
CLOTHING, JEWELRIES, GADGETS 2017 105,000.00

Subtotal : 211,000.00
TOTAL ASSETS (a+b): 211,000.00
* Additional sheet/s may be used, if necessary.

4. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

SALARY, EMERGENCY, POLICY PSSLAI 209,772.00

LOANS
PROVIDENT LOAN PRO 13 CARAGA 63,888.80
SALARY LOAN SSS 30,000.00
303,660.80
NET WORTH : Total Assets less Total Liabilities = -92,660.80
* 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

ENTITY/BUSINESS INTEREST &/OR FINANCIAL OF INTEREST OR
ENTERPRISE CONNECTION CONNECTION
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
DIONIVER T. MEDRANO BROTHER SR. REC. CUSTODIAN SSS MAIN OFFICE, DILIMAN, QUEZON CITY
CAROLINA MEDRANO SISTER TEACHER SPED BUTUAN CENTRAL ELEM. SCHOOL
ISOBAL

I hereby certify that these are true and correct statements of my assets, liabilities, net
Page 6 of ___
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: _ FEBRUARY 6, 2018__

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

Government Issued ID: PNP ID Government Issued ID:

ID No.: 15C200312 ID No.:
Date Issued: 3/20/2015 Date Issued:

SUBSCRIBED AND SWORN to before me this 14th day of February 2018, affiant exhibiting to me
the above-stated government issued identification card.

PSUPT SHIRLEY O ESTRADA

(Person Administering Oath)

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, 2017
(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: SAMORIN RONALD WILBUR E. POSITION: P.E. PNCO
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: RHS 13
ADDRESS: P2, BLK 4, LOT 11, EMILY HOMES, LIBERTAD, OFFICE ADDRESS: LIBERTAD, BUTUAN CITY
BUTUAN CITY

SPOUSE: SAMORIN GINA A. POSITION: N/A

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

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S

HOUSEHOLD

NAME DATE OF BIRTH AGE

KENNETH A. SAMORIN SEPTEMBER 8, 2001 16Y/O
KEANU JAMES A. SAMORIN JULY 14, 2002 15Y/O
KATHLEEN GRACE A. SAMORIN DECEMBER 3, 2005 12Y/O

ASSETS, LIABILITIES AND NETWORTH

(Including those of the spouse and unmarried children below eighteen (18)
Page 7 of ___
 years of age living in declarant’s household)

1. ASSETS
a. Real Properties*

DESCRIPTIO KIND EXACT ASSESSED CURRENT ACQUISITION ACQUISITION

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

HOUSE RESIDENTIAL BUTUAN CITY 2001 PAG- 650,000.00

AND LOT IBIG

Subtotal: 650,000.00

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT

MITSUBISHI VAN (LET 651) 2004 130,000.00

JEWELRIES AND GADGETS 2017 255,000.00
XRM 125 HONDA MOTOR 2014 61,500.00

Subtotal : 446,500.00
TOTAL ASSETS (a+b): 1,096,500.00
* Additional sheet/s may be used, if necessary.

5. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

LOANS AFPSLAI, PSSLAI, PSMBFI AND 986,358.36

PROVIDEND

986,358.36
NET WORTH : Total Assets less Total Liabilities = 110,141.64
* 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

ENTITY/BUSINESS INTEREST &/OR FINANCIAL OF INTEREST OR
ENTERPRISE CONNECTION CONNECTION
N/A N/A N/A N/A

Page 8 of ___
 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
SPO2 LOUIE E. SAMORIN BROTHER OPERATION PNCO REGIONAL HEALTH SERVICE 13

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: _ FEBRUARY 15, 2018__

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

Government Issued ID: PNP ID Government Issued ID: CTC

ID No.: 17K220087 ID No.: 08477434
Date Issued: 11/22/2017 Date Issued: JAN. 25, 2018

SUBSCRIBED AND SWORN to before me this 15th day of February 2018, affiant exhibiting to me
the above-stated government issued identification card.

PSUPT SHIRLEY O ESTRADA

(Person Administering Oath)

Page 9 of ___
Page 10 of ___