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Republic of the Philippines )

Province of Northern Samar ) SS


Municipality of Catarman )

AFFIDAVIT OF NO RETURN TO SERVICE

I, TERESITA A. LOBOS, Filipino, of legal age and a resident of San Roque, Northern Samar, after
having been duly sworn to in accordance with law, do hereby depose and state:

1. That I am a public school teacher at the Department of Education, Division of Northern Samar,
Catarman, Northern Samar and is assigned at San Roque Central Elementary School, San Roque,
Northern Samar;

2. That I have applied for early retirement at the age of sixty-one (61) years of age effective
September 1, 2017, which application have already been approved and my accountabilities having
been cleared already;

3. That by availing of my privilege for early retirement and by execution of this affidavit, I no longer
intend to return to service;

4. That I am executing this Affidavit to attest to the truth of the foregoing, for the purpose of my
application for early retirement, and for whatever legal purposes it may serve.

IN VIEW WHEREOF, I have hereunto set my hand this 5th day of September 2017 at Catarman,
Northern Samar.

TERESITA A. LOBOS
Affiant
Valid ID No.: PRC 0528299
Issued by/on: PRC valid until 9/20/2019

SUBSCRIBED AND SWORN TO before me, a Notary Public, this 5th day of September 2017 at
Catarman, Northern Samar.

Doc. No. ___; ATTY. CESAR NORMAN Y. CALAMAY


Page No. ___; Notary Public
Book No. II; Province of Northern Samar
Series of 2017. Roll No. 61964
Commission No. 04-2017
Commission Expiry: 12/31/2018
IBP Life No. 015923/3-3-2017
PTR No. 3494029/3/9/2017
Catarman, Northern Samar