NOTARIZED AFFIDAVIT OF LOSS SAMPLE
A Notarized Affidavit of Loss is usually required when requesting for a replacement of a lost document or item.
The statement or narration of facts is made based on the truthful knowledge of the person, called the Affiant.
Used in a variety of legal proceedings, it is a legal document bearing a sworn statement of facts that can be used for declaring the loss of a document such as ID, Driver’s License, Credit Card, ATM Card, Vehicle Title, Passport or an object owned by the Affiant.
The affidavit is going to be used to support an application for a replacement of the lost item.
AFFIDAVIT OF LOSS REQUIREMENTS
Write down the important facts you want to state in the affidavit:
- Full name, age, address
- What was lost
- Relationship to the object or thing lost. Do you own it?
- Where was it the last time you remember seeing it?
- What efforts did you take to find it? Where did you search for it?
It must be sworn to or subscribed before a person authorized to administer oaths, such as a Notary Public.
After completing the affidavit, the Affiant must:
- Personally appear before a notary public
- Present at least one current document of identification issued by an official agency containing the signature and photograph of the Affiant.
- Swear under oath the whole truth of the contents of the affidavit
- Sign all copies of the affidavit.
- In case the Affiant is a minor, a legal guardian must be present when signing the affidavit.
- The legal guardian must also sign the affidavit.
- Print at least 2 copies of the document.
- Leave one original copy for the notary public files
If the statements are not the whole truth, nothing but the truth the affinat will be liable for perjury.
Notarized Affidavit of Loss Format Sample
AFFIDAVIT OF LOSS
I, ____________, age _____ Marital status ______ resident of ______________________________, hereby DECLARE after being sworn
in accordance with the law of the State of ______________ That:
I am the owner of ____________________________
The last time I remember seen it was on ______________ at the __________________
I have made numerous attempts to recover said object including: ___________________________________________________
___________________________________________________
After all efforts made to find said object with no avail, I have concluded the object is irretrievably lost or destroyed and cannot be located.
I execute this affidavit to attest to the truth of the foregoing declared facts.
_________________________ _________________________
Affiant’s Signature Affiant’s Printed Name
_________________________ _________________________
Witness' Signature Witness' Printed Name
SWORN TO and subscribed before me this day of _____________, 20____ .
________________________
Notary Public's Signature
________________________
Notary Public's Printed Name
My Commission Expires _________________
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