AFFIDAVIT OF LOSS
I, ____________, of legal age, ____________, and with ____________ and currently residing at ____________, under oath, depose and state:
- That I am the true and lawful owner of ____________ (hereinafter referred to as “the subject item”).
- That the subject item was lost on ____________ at ____________.
- That I have searched for the subject item in all possible places where it could be found but to no avail.
- That I have reported the loss of the subject item to the ____________.
- That I am executing this Affidavit of Loss to attest to the truth of the above-stated facts and to request for a replacement of the subject item.
IN WITNESS WHEREOF, I have hereunto set my hand this ____________ at ____________.
Affiant
SUBSCRIBED AND SWORN to before me this ____________, affiant exhibiting to me his/her ____________ as proof of identity.
Notary Public
*Note: This is an example of an Affidavit of Loss, and it is important to consult with a lawyer or legal professional before using this document.
