Affidavit of Loss
  • Affidavit Details
    • Who is Affiant?
    • General Information
    • Details of Loss
  • Complete the Document
    • Format & Signatures

Who is Affiant?

  • Indicate the full name of an affiant (a person, who issues this affidavit):

  • Select the affiant's date of birth:

  • Indicate the affiant's current residential address:

  • Provide the affiant's state and city/town of birth:

  • Indicate the Affiant's social security number:

General Information

  • Which document is the Affiant presenting to the notary to verify his or her identity?

  • Indicate the full name of identification document the Affiant is presenting to the notary:

  • Indicate the name of the county where the Affiant currently resides:

  • Select the state, where the Affiant currently resides:

Details of Loss

  • The Affiant lost:

  • Provide a detailed description of the item/object that the Affiant has lost:

  • The following document was lost:

  • Indicate the name and type of the lost document:

  • Indicate the passport number:

  • Select the date on which the passport was issued:

  • Indicate the number of a driving license:

  • Select the date on which the driving license was issued:

  • Indicate the ID number of a stock certificate:

  • Select the date on which the stock certificate was issued:

  • Indicate the full name of an organization/institution that issued a diploma:

  • Select the date on which the diploma was issued:

  • Select the date on which the document was issued:

  • Describe the circumstances under which the item/object was lost:

  • Do you want to add a signature?

  • Affiant's signature:

Select a template's format:

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DOCX
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