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Affidavit Of Loss Form
"I need an Affidavit of Loss Form for my missing share certificates from ABC Corporation (certificate numbers 12345-12350), which were lost during an office relocation on January 15, 2025, to submit to my bank for replacement certificates."
1. Title and Declaration: Identifies the document as an Affidavit of Loss and includes declarant's details
2. Personal Information: Full legal name, address, and occupation of the person making the declaration
3. Description of Lost Item: Detailed description of the lost item including identifying features, numbers, or references
4. Circumstances of Loss: Detailed account of how, when, and where the item was lost
5. Statement of Truth: Declaration that all statements made are true and accurate
6. Execution Block: Space for signature, date, and notary/commissioner for oaths authentication
1. Search Efforts: Description of attempts made to locate the lost item - include when required by receiving institution or to strengthen the affidavit
2. Police Report Reference: Details of any police report filed - include when a police report has been filed or is required by receiving institution
3. Indemnification Statement: Statement indemnifying the receiving institution - include when required by receiving institution, particularly for financial instruments
1. Copy of Identification: Certified copy of declarant's identification documents
2. Supporting Documents: Any relevant documentation proving ownership or existence of lost item
3. Police Report: Copy of police report if filed
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