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Affidavit of Lost Document Template
Confirm a missing original document with a sworn Affidavit of Lost Document for replacement and record purposes using this template.
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Affidavit of Lost Document Template
This Affidavit of Lost Document (the “Affidavit”) is made on [Date] by:
Affiant: [Full Name or Business Legal Name], address: [Address], phone/email: [Contact].
Role (Optional): ☐ Owner ☐ Party to document ☐ Authorized representative ☐ Other: [Explain]
1. Document Information
1.1 Document Type/Title: [Title]
1.2 Date Issued/Executed: [Date]
1.3 Parties/Issuer (If Any): [Names]
1.4 Reference/Serial/Account No. (If Any): [__]
1.5 Document Purpose (Optional): [What it relates to].
2. Loss Details
2.1 Last Known Location: [Where it was last seen].
2.2 Date Last Seen (Approx.): [Date]
2.3 How It Was Lost (If Known): [Brief explanation].
2.4 Search Efforts: I have made a reasonable search for the original document, including: [List steps].
2.5 Theft Suspicion: ☐ Not suspected ☐ Suspected (details): [Explain].
2.6 Police Report (If Any): ☐ Not filed ☐ Filed (agency: [], report no.: [], date: [__]).
3. Replacement / Reissue Request
3.1 I request: ☐ a replacement original ☐ a certified copy ☐ reissuance/retitling ☐ record update ☐ other: [Request].
3.2 Any known fees or procedures: [If known].
4. Indemnity (Optional)
4.1 If required by the recipient, I agree to indemnify and hold the recipient harmless from losses arising from reliance on this Affidavit, except as prohibited by law.
5. Attachments (Optional)
5.1 ☐ Copy/photo/scan of the document (if available)
5.2 ☐ Correspondence referencing the document
5.3 ☐ Proof of identity/authority
5.4 ☐ Police report (if filed)
5.5 ☐ Other: [List]
6. Statement Under Oath
6.1 I declare under penalty of perjury that the statements in this Affidavit are true and correct to the best of my knowledge.
Signatures
Affiant: [Full Name/Business Name]
Date: [Date]
Signature: ___________________________
Witnesses (If Required)
Witness Name: [Name]
Date: [Date]
Signature: ___________________________
Notary / Notarization (If Required)
State of [State]
County of [County]
On [Date], before me, [Notary Name], personally appeared [Affiant Name], known to me (or satisfactorily proven) to be the person whose name is subscribed to this Affidavit, and acknowledged that they executed it for the purposes stated.
Notary Public Signature: _______________________
My Commission Expires: _______________________
Notary Seal (if applicable): ___________________
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Easy-to-understand jargon
Easy-to-understand jargon
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Affidavit of Lost Document Template
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For quick answers, scroll below to see the FAQ.
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
AFFIDAVIT OF LOST DOCUMENT TEMPLATE FAQ
What is an affidavit of lost document?
An Affidavit of Lost Document is a sworn statement that an original document has been lost, misplaced, or destroyed and cannot be located after a reasonable search. It is often used to request a replacement, reissue, or administrative update from an institution, agency, or counterparty.
When should you use it?
Use it when an organization requires proof that the original document cannot be produced — for example, a lost title, stock certificate, promissory note, contract original, or notarized record. This template includes a “reasonable search” statement and a place to describe the circumstances.
What information should be included?
Include: the document title/type, date, parties, identifying numbers, last known location, the steps taken to search, and whether you believe the document was stolen. This template includes optional theft reporting and replacement request language.
Do you need notarization?
Often yes. Notarization is commonly required for affidavits used for replacements or official records. This template includes notarization and an optional witness section.
Should you attach copies?
Yes if you have them. Attach copies, photos, emails, or any proof that the document existed. This template includes a checklist for common attachments.
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