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Statement of Assets, Liabilities and Networth (SALN) As of December 31, 2005

The Statement of Assets, Liabilities and Networth (SALN) shall contain a true and complete declaration of assets, liabilities and networth as of December 31, 2005. This form shall be filed in duplicate by Individuals, whether resident or nonresident citizens, or resident or nonresident aliens, Estates, Trusts, Corporations, Cooperatives and tax exempt entities that have become taxable as of December 31, 2005 and other juridical entities including partnerships liable to pay any internal taxes covering the taxable year ending December 31, 2005 and prior years, availing the Tax Amnesty under R.A. No. 9480. The Statement of Assets, Liabilities and Networth (SALN) shall contain a true and complete declaration of assets, liabilities and networth as of December 31, 2005. This form shall be filed in duplicate by Individuals, whether resident or nonresident citizens, or resident or nonresident aliens, Estates, Trusts, Corporations, Cooperatives and tax exempt entities that have become taxable as of December 31, 2005 and other juridical entities including partnerships liable to pay any internal taxes covering the taxable year ending December 31, 2005 and prior years, availing the Tax Amnesty under R.A. No. 9480.

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(Name of Taxpayer)

Statement of Assets, Liabilities and Networth (SALN)
As of December 31, 2005
ASSET

REFERENCE

LOCATION

BASIS OF VALUATION

VALUE (In Philippine Peso)

(Domestic and
Foreign Business
and Non-Business)

(OCT/TCT/CCT No./
Tax Declaration No.
Motor No./Chassis No.)

(Exact address of real properties and
location of bank deposits & other personal
properties)

(Size/Area for Land &
Bldg.; No. of shares for
stocks; units for bond)

(Cost, if acquired by purchase/
zonal value or fair market value
(whichever is higher), if by
inheritance or donation)

DESCRIPTION

Land
Land and Building
Machinery and Equipment
Other Real Assets
Total
Personal and/or Intangibles
Current Business Inventory/Stock-in-Trade
Machinery and Equipment
Assets*
Furniture and Fixtures
Investment
Jewelry
Transportation Equipment
Shares of Stock (state
Real*

issuing co. & no. of shares)
Cash on hand (in peso)
Cash on hand (in foreign currency)
Cash in bank/s (in peso)
Cash in bank/s (in foreign currency)

Other Personal and/or
Current Business Assets
Total
Other Assets*
TOTAL ASSETS
LIABILITIES*
(Legitimate and
Enforceable)

DESCRIPTION

CREDITOR

OUTSTANDING BALANCE

Accounts Payable
Notes Payable
Loans
Mortgage Payable
Other Liabilities
TOTAL LIABILITIES
NETWORTH (difference between total assets and total liabilities)
*Assets and liabilities recorded in any foreign currency must be stated at peso value using conversion rate as of December 31, 2005
I hereby certify and declare under the penalties of perjury, that the above information is a true statement of my/the corporation's assets, liabilities and networth as of
December 31, 2005, as required by and in accordance with Republic Act No. 9480.
President/Vice President/Principal Officer/
Authorized Representative/Taxpayer
(Signature Over Printed Name)
(Please see back portion for the guidelines and instructions)

GUIDELINES AND INSTRUCTIONS
Contents of the Statement of Assets, Liabilities and Networth (SALN)
The SALN shall contain a true and complete declaration of assets, liabilities and networth as of December 31, 2005, as follows:
1.

Assets within or without the Philippines, whether real or personal, tangible or intangible, whether or not used in trade or business;
a)

Real properties shall be accompanied by a description of their classification, exact location, and valued at acquisition cost, if acquired by purchase, or the
zonal valuation or fair market value, whichever is higher, if acquired through inheritance or donation;
b) Personal properties other than money, shall be accompanied by a specific description of the kind and number of assets (i.e. automobiles, shares of stock,
etc.) or other investments, indicating the acquisition cost less depreciation or amortization, in proper cases, if acquired by purchase, or the fair market price
or value at the time of receipt, if acquired through inheritance or donation;
c) Assets denominated in foreign currency shall be converted into the corresponding Philippine currency equivalent, at the rate of exchange prevailing as of
December 31, 2005; and
d) Cash on hand and in bank in peso as of December 31, 2005, as well as Cash on hand and in bank in foreign currency, converted to peso as of December 31,
2005.
2.

All existing liabilities which are legitimate and enforceable, secured or unsecured, whether or not incurred in trade or business, disclosing or indicating clearly the
name and address of the creditor and the amount of the corresponding liability.

3.

The total networth of the taxpayer, which shall be the difference between the total assets and the total liabilities.

NOTE:
1. All background information must be properly filled-up.
2. Attach supporting schedules, if necessary, with details required in the SALN.
 
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