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An Affidavit of Loss is a sworn written statement in which the affiant declares under penalty of perjury that a specific document, certificate, or valuable item has been irretrievably lost, stolen, or destroyed and cannot be produced. Executed before a notary public, it gives the declaration legal force β establishing the factual basis a bank, government registry, share registrar, or court needs to issue a replacement without risking liability if the original later surfaces. Unlike a simple written notice, a notarized affidavit creates a personal legal obligation on the affiant: making a false statement in one is a criminal offence in every major jurisdiction.
Without a notarized affidavit of loss, virtually every institution responsible for issuing replacement documents will refuse to act. Banks will not reissue a promissory note or passbook, land registries will not issue a duplicate title deed, and share registrars will not cancel a lost certificate and issue a replacement β all because doing so without sworn proof exposes the institution to double liability if the original turns up in someone else's hands. The indemnity clause in a properly drafted affidavit shifts that risk back to you, giving the institution the legal protection it needs to proceed. A missing clause, a vague item description, or an unnotarized signature is sufficient to have the document returned and the replacement process restarted from scratch β costing weeks of delay and, in the case of financial instruments, potential financial loss. This template provides every required clause in the correct order, formatted for notarization and ready for the specific institutions most likely to request it.
| If your situation is⦠| Use this template |
|---|---|
| Reporting the loss of a stock or share certificate | Affidavit of Loss β Share Certificate |
| Declaring a lost original promissory note to a lender | Affidavit of Lost Note |
| Notifying an insurer of a lost original insurance policy | Affidavit of Loss β Insurance Policy |
| Reporting a lost title deed to a land registrar | Affidavit of Loss β Title Deed |
| Replacing a lost corporate seal or resolution document | Affidavit of Loss β Corporate Document |
| Documenting loss of a government-issued license or permit | Affidavit of Loss β License or Permit |
| General sworn statement for any lost personal or business item | General Affidavit of Loss |
Why it matters: Notarization requires the affiant to sign in the notary's physical presence after taking an oath. A pre-signed affidavit is legally defective and will be rejected by courts and institutions.
Fix: Print the completed affidavit, leave the signature block blank, and sign only at the notary appointment after the oath is administered.
Why it matters: Descriptions like 'a share certificate' or 'a bank document' give the institution nothing to match against its records, stalling or blocking the reissuance process entirely.
Fix: Include the exact document type, serial or reference number, issuing authority's full legal name, and original date of issuance β sourced directly from prior correspondence or records.
Why it matters: Without an indemnity, the institution bears full risk if the original document surfaces later and is presented by a third party β most will refuse to reissue without it.
Fix: Include a broadly worded indemnity covering all claims, damages, costs, and legal expenses arising from any later presentation of the original document.
Why it matters: Many financial institutions and government agencies require evidence of a theft report before processing a replacement for high-value instruments. Omitting it delays processing and may trigger a surety bond requirement.
Fix: File a police report before completing the affidavit and include the report date and reference number in the circumstances-of-loss clause.
Why it matters: Each jurisdiction has specific statutory wording for sworn declarations. Using language from a different state, province, or country can render the affidavit legally insufficient in the jurisdiction where it is filed.
Fix: Confirm the governing jurisdiction with the receiving institution and use that jurisdiction's prescribed declaration language β or have a local notary supply the correct wording.
Why it matters: Different institutions β banks, land registries, share registrars, and courts β have different affidavit formats, additional clauses, or accompanying bond requirements. A generic affidavit that misses a mandatory field will be returned.
Fix: Contact the institution before completing the template to obtain their specific checklist, and verify whether they require a surety bond or lost instrument bond alongside the affidavit.
In plain language: States the full legal name, address, and capacity of the person making the sworn declaration.
I, [AFFIANT FULL NAME], of legal age, with address at [COMPLETE ADDRESS], [CITY, STATE/PROVINCE, POSTAL CODE], do hereby solemnly swear and depose as follows:
Common mistake: Using a nickname or trade name instead of the affiant's full legal name as it appears on government-issued identification β this can cause the notary to refuse certification or the receiving institution to reject the document.
In plain language: Identifies the document or item in precise detail β type, reference number, issuing authority, and date of issuance.
That I am/was the registered owner of [DOCUMENT TYPE] No. [REFERENCE NUMBER], issued by [ISSUING AUTHORITY] on [DATE OF ISSUANCE], covering [BRIEF DESCRIPTION OF SUBJECT MATTER].
Common mistake: Providing a vague description such as 'a financial document' rather than the exact document type, serial number, and issuing authority β institutions use these details to locate the original record and verify the loss.
In plain language: Describes when, where, and how the item was lost, stolen, or destroyed, to the best of the affiant's knowledge.
That on or about [DATE], the above-described [DOCUMENT TYPE] was lost/stolen/destroyed under the following circumstances: [DESCRIBE CIRCUMSTANCES IN DETAIL]. Despite diligent search, the said document has not been found.
Common mistake: Writing only 'the document was lost' without any circumstances. Many institutions and courts require at least minimal circumstances to guard against fraudulent affidavits and to assess whether a surety bond is warranted.
In plain language: Confirms that the affiant made a thorough, good-faith effort to locate the item before declaring it lost.
That I have diligently searched for the said [DOCUMENT TYPE] in all places where it might reasonably be found, including [LOCATIONS SEARCHED], and have been unable to locate the same.
Common mistake: Omitting the diligent search declaration entirely. Without it, institutions may require additional evidence of the loss or refuse to process the replacement request altogether.
In plain language: Affirms that the affiant is the lawful owner or authorized representative with the right to request replacement of the lost item.
That I am the lawful owner/authorized representative of the above-described [DOCUMENT TYPE] and that no other person has any right, title, or interest therein, nor has the same been endorsed, transferred, pledged, or otherwise disposed of.
Common mistake: Failing to include a representation that the document has not been pledged, transferred, or endorsed to a third party β without this, the issuing institution cannot safely reissue without risking double liability.
In plain language: The affiant agrees to hold harmless and indemnify the issuing institution against any claim arising if the original document is found and presented by a third party after reissuance.
That in consideration of the issuance of a replacement [DOCUMENT TYPE], I hereby undertake to indemnify and hold harmless [INSTITUTION NAME] from any and all claims, damages, costs, and expenses arising from the presentation or enforcement of the original [DOCUMENT TYPE] by any third party.
Common mistake: Drafting the indemnity too narrowly β for example, limiting it to direct losses only. A broad indemnity covering consequential damages and legal costs gives the issuing institution the protection it needs to proceed with reissuance.
In plain language: Formally requests that the institution issue a duplicate, replacement, or certified copy of the lost document.
WHEREFORE, I hereby respectfully request that [INSTITUTION NAME] issue a replacement/duplicate [DOCUMENT TYPE] in lieu of the lost original, subject to such terms and conditions as [INSTITUTION NAME] may impose.
Common mistake: Omitting a formal request clause and assuming the sworn statement alone is sufficient. Many institutions require an explicit written request within the body of the affidavit to initiate their internal replacement procedures.
In plain language: A closing statement affirming that all facts stated in the affidavit are true and correct to the best of the affiant's knowledge.
I hereby declare under penalty of perjury under the laws of [STATE/PROVINCE/COUNTRY] that the foregoing is true and correct to the best of my knowledge and belief.
Common mistake: Copying a declaration from a jurisdiction other than the one governing the affidavit. Different jurisdictions use different statutory language for the perjury declaration β using the wrong form can undermine the document's evidentiary weight.
In plain language: The affiant's dated signature executing the affidavit before the notary public.
IN WITNESS WHEREOF, I have hereunto set my hand this [DAY] day of [MONTH], [YEAR]. ______________________________ [AFFIANT FULL NAME]
Common mistake: Signing the affidavit before appearing before a notary. The affiant must sign in the physical presence of the notary for the notarization to be valid β a pre-signed document will be rejected.
In plain language: The notary public's certification that the affiant appeared in person, was identified, and took the oath before signing.
SUBSCRIBED AND SWORN to before me this [DAY] day of [MONTH], [YEAR], at [CITY, STATE/PROVINCE]. ______________________________ Notary Public | Commission No.: [NUMBER] | My Commission Expires: [DATE]
Common mistake: Leaving the notarization block blank and submitting the affidavit without a notary seal. An unnotarized affidavit has no evidentiary value and will be rejected by every financial institution and government registry without exception.
Before opening the template, collect the full name of the document or item, its serial or reference number, the name of the issuing authority, and the original date of issuance. Contact the issuer if necessary to confirm exact identifiers.
π‘ Most institutions require the reference number to match their internal records exactly β a digit transposed in a certificate number is sufficient grounds to reject the affidavit.
Type the affiant's full legal name as it appears on a government-issued photo ID, complete residential or business address, and β where required by the institution β a government ID number or date of birth.
π‘ Bring the same ID to the notary appointment. The notary is required to verify identity and will record the ID type and number on the jurat.
Complete the description clause with the document type, all reference numbers, the issuing authority's full name, and the date of issuance. If the item is a financial instrument, include its face value and any registered holder details.
π‘ Copy the description verbatim from any prior correspondence, statements, or records you have for that item β institutions match this language against their records.
Write a clear, specific account of when and where the item was last seen, the circumstances under which it was lost or stolen, and every location searched. If theft is suspected, include the date and reference number of the police report.
π‘ A police report number adds credibility and is sometimes mandatory for lost financial instruments β file it before completing this step.
Confirm that you are the sole owner with no outstanding encumbrances, pledges, or transfers. Review the indemnity language and ensure it covers all claims the institution could face, including legal costs and consequential losses.
π‘ If the institution provides its own indemnity form or bond requirement, ask for it before drafting this clause β some institutions will not accept third-party indemnity language.
Print the completed affidavit but do not sign it. Bring the unsigned document and a valid government-issued photo ID to your notary appointment.
π‘ Schedule the notary appointment at the institution that will receive the affidavit when possible β some banks and registrars have on-site notaries who are familiar with their own acceptance requirements.
Sign the affidavit in the notary's physical presence after taking the oath. Confirm the notary completes the jurat in full β date, location, commission number, expiry date, and official seal or stamp.
π‘ Request two certified copies at the notary appointment β most institutions keep the original and some replacement processes require a copy for your own records.
Deliver the notarized affidavit to the relevant institution along with any required supporting documents β such as a police report, surety bond, or application form β and retain a copy of the submission confirmation.
π‘ Follow up in writing within five business days if you do not receive an acknowledgement. Institutions sometimes route affidavits to a specialist department that operates on a separate processing timeline.
An affidavit of loss is a sworn written statement in which a person declares under oath that a specific document, certificate, or valuable item has been lost, stolen, or destroyed and cannot be produced. It is notarized to give it legal weight and submitted to the institution β such as a bank, land registry, or share registrar β responsible for issuing a replacement. Without it, most institutions will not proceed with reissuance.
You need one whenever an institution requires formal sworn proof of loss before issuing a duplicate or replacement. Common scenarios include replacing a lost share certificate, requesting reissuance of a promissory note or bond, obtaining a duplicate title deed, replacing a lost insurance policy, or recovering a government-issued license or permit. The institution requesting it will specify whether notarization and a surety bond are also required.
Yes, in virtually all circumstances. Notarization is what transforms a written statement into a sworn legal document β the notary public verifies the affiant's identity, administers the oath, witnesses the signature, and certifies the document with their official seal. An unnotarized affidavit of loss will be rejected by courts, financial institutions, and government registries in every major jurisdiction.
An affidavit of loss is a sworn statement establishing the fact of loss. A surety bond β sometimes called a lost instrument bond β is a financial guarantee, usually from an insurance company, that reimburses the issuing institution if the original document is later found and presented by a third party. Many institutions require both: the affidavit to establish loss and the bond to manage financial risk. The bond amount is typically 1.5 to 2 times the face value of the lost instrument.
For straightforward losses β a misplaced share certificate, a lost savings passbook, or a missing title deed β a high-quality template is typically sufficient. Engaging a lawyer is advisable when the lost item is a high-value negotiable instrument, when the loss is contested, when the affidavit will be filed in litigation, or when the institution requires jurisdiction-specific statutory language that differs from the template's defaults. A lawyer review for a standard affidavit of loss typically takes one to two hours.
If the original surfaces after a replacement has been issued, the affiant is obligated under the indemnity clause to notify the institution immediately and return or cancel one of the instruments. Presenting both the original and the replacement to collect double payment is fraud and can result in criminal charges. The surety bond β if one was posted β provides the institution's financial recourse in this scenario.
They are closely related but not identical. A statutory declaration is made under specific statutory authority (for example, the Canada Evidence Act or the UK Statutory Declarations Act 1835) and does not always require an oath β affirmation is typically permitted. An affidavit is made under oath before a notary or commissioner of oaths and carries the specific penalty of perjury. Many institutions accept either form, but some β particularly courts and land registries β specify which is required.
Processing times vary by institution and document type. Banks typically process replacement passbooks or certificates within 5 to 15 business days after receiving a complete affidavit package. Land registries and government agencies can take 4 to 12 weeks. Share registrars handling publicly traded stock certificates may require additional board approval and surety bond verification, extending the timeline to 30 to 60 days. Submitting a complete, properly notarized package with all required supporting documents is the single most effective way to avoid delays.
Ask the institution for the specific reason in writing. The most common rejection reasons are a missing notary seal, a vague item description, an absent indemnity clause, or mismatched perjury declaration language. Correct the identified deficiencies and re-execute the affidavit β do not simply amend a rejected document, as the original execution date will be wrong. If the rejection reason is unclear or the institution applies requirements not disclosed in advance, consider engaging a lawyer to correspond on your behalf.
A statutory declaration is made under statutory authority and may be affirmed rather than sworn, while an affidavit is specifically made under oath before a notary with the penalty of perjury attached. Courts and land registries often specify which form is required. In Canada and the UK, a statutory declaration is frequently accepted in place of an affidavit for administrative purposes, but not in litigation.
A general affidavit is an open-form sworn statement that can cover any factual matter. An affidavit of loss is a purpose-specific affidavit with required clauses β diligent search, indemnity, and a formal replacement request β that a general affidavit template will not include by default. Use the affidavit of loss when an institution explicitly requires proof of loss rather than a general sworn statement.
An affidavit of ownership confirms that the affiant holds title to a property or asset β it establishes ownership, not loss. An affidavit of loss focuses on the fact that an original document cannot be produced and formally requests a replacement. The two are sometimes submitted together when an institution requires both proof of ownership and proof of loss before reissuing a certificate or title.
A lost instrument bond is a financial surety product, not a document template. It provides a monetary guarantee to the issuing institution rather than a sworn statement. Many institutions require both the affidavit of loss and a lost instrument bond for high-value negotiable instruments. The affidavit establishes the sworn facts; the bond provides the financial backstop if the original later appears.
Replacement of lost promissory notes, bonds, passbooks, and bearer instruments β typically requires a lost instrument bond equal to 1.5 to 2 times the instrument's face value alongside the affidavit.
Reporting lost title deeds or mortgage documents to land registries, where the affidavit must describe the land parcel by legal description and confirm no third-party encumbrances have been registered.
Replacing lost share certificates with a share registrar or transfer agent, which typically requires board authorization and a surety bond in addition to the notarized affidavit.
Requesting a duplicate of a lost original insurance policy before a claim can be processed or coverage confirmed β insurers typically require the affidavit from the named insured or their authorized representative.
Affidavits of loss in the US must be notarized by a state-commissioned notary public. Requirements vary by state β California and New York impose specific notarization wording, and some states require the notary to administer a verbal oath rather than simply witnessing a signature. For lost negotiable instruments under the Uniform Commercial Code (UCC Article 3), the institution may require a lost instrument bond equal to twice the instrument's face value in addition to the affidavit.
In Canada, affidavits must be sworn before a commissioner of oaths, notary public, or other officer authorized under provincial legislation. Many institutions also accept a statutory declaration under the Canada Evidence Act. Quebec requires French-language documentation for provincially-regulated institutions. Provincial land registry offices have their own prescribed affidavit forms that must be used instead of a generic template.
In England and Wales, an affidavit of loss may be sworn before a solicitor, a commissioner for oaths, or a court officer. The Statutory Declarations Act 1835 provides an alternative form accepted by most administrative bodies. For HM Land Registry matters, specific prescribed forms apply and a general affidavit template is not sufficient. Scotland has a separate legal system with its own requirements under the Requirements of Writing (Scotland) Act 1995.
EU member states have widely varying requirements for sworn declarations, and there is no single EU-wide standard for an affidavit of loss. In civil-law jurisdictions such as France, Germany, and Spain, a notarial act (acte notariΓ©) before a civil-law notary is typically required rather than a common-law-style affidavit. Cross-border use within the EU may require apostille certification under the Hague Convention to be recognized in another member state. GDPR compliance applies where personal data of identifiable individuals is processed in the affidavit.
| Path | Best for | Cost | Time |
|---|---|---|---|
| Use the template | Individuals and businesses replacing routine lost documents β share certificates, passbooks, licenses, or title deeds β with a single institution | Free (plus notary fee of $10β$50) | 1β2 hours to complete plus notary appointment |
| Template + legal review | High-value instruments, cross-border submissions, or situations where the institution imposes jurisdiction-specific language requirements | $150β$400 for a 1-hour lawyer review | 1β3 days |
| Custom drafted | Lost negotiable instruments in litigation, estate proceedings involving missing original wills or deeds, or multi-jurisdiction filings | $500β$2,000+ | 3β10 business days |
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