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PERSONAL STATEMENT OF ASSETS AND LIABILITIES

OF PARENTS / LEGAL GUARDIAN

I, , of legal age, single/married and a resident


of , hereby state:

1. That my familys assets and liabilities as of 31 December 20 , are as follows:

A. Assets

Personal Properties Cost

Savings P
Stocks/Investments
Vehicles
Jewelry
Furniture
Appliances
Others
Total Personal Properties P

Real Properties Market Value

Residential lands P
Non-residential lands
Residential buildings
Non-residential buildings
Total Real Properties P

Total Assets P

B. Liabilities
P

Total Liabilities P

C. Net Worth (A B)
Total Assets less Total Liabilities P

2. That this personal statement of


(Name of Student)
is made to support the application for St. La Salle Financial Assistance Grant.

Date
Printed Name & Signature of Parent(s)/Guardian