Affidavit of Loss of Document

AFFIDAVIT OF LOSS I, [deponent_name], son/daughter/wife of [deponent_father_name], aged about [deponent_age] years, residing at [deponent_address], do hereby solemnly affirm and state on oath as follows: 1. That I am the deponent herein and am competent to swear this affidavit. 2. PARTICULARS OF THE DOCUMENT Document : [document_lost] Number : [document_number] Issued to : [deponent_name] 3. That the said document was issued to me and was in my lawful possession. 4. CIRCUMSTANCES OF THE LOSS [circumstances_of_loss] The loss occurred on or about [loss_date]. 5. That despite a diligent and thorough search at all places where the document could reasonably be expected to be, I have been unable to trace it, and I believe it to be irretrievably lost. 6. That I have lodged a report with the police in respect of the loss, bearing complaint number [police_report_number]. 7. DECLARATIONS 7.1 That the said document has NOT been sold, pledged, mortgaged, deposited, transferred, or otherwise disposed of by me to any person, nor has it been given as security to any person. 7.2 That no other person has any right, title, interest or claim in respect of the said document. 7.3 That the document has not been misused to my knowledge, and I have not authorised any person to use it. 7.4 That if the said document is found or recovered at any time hereafter, I undertake to surrender it forthwith to [issuing_authority], and not to use it for any purpose. 8. That this affidavit is being made for the purpose of applying to [issuing_authority] for the issue of a duplicate of the said document. 9. INDEMNITY That I hereby undertake to indemnify and keep indemnified [issuing_authority] against any loss, claim, cost or liability that may arise on account of the issue of a duplicate document to me, or on account of any statement made in this affidavit being incorrect. 10. That the statements made above are true to my personal knowledge, that nothing material has been concealed, and that I am aware that a false statement in this affidavit would render me liable to prosecution in accordance with law. DEPONENT [deponent_name] VERIFICATION I verify that the contents of paragraphs 1 to 10 of this affidavit are true and correct to the best of my knowledge and belief, that no part of it is false, and that nothing material has been concealed. Verified at [place] on this [affidavit_date]. DEPONENT [deponent_name] SWORN AND SIGNED BEFORE ME Notary Public / Oath Commissioner Regn. No.: Seal: PRACTICAL NOTES - LODGE A POLICE COMPLAINT FIRST for any document that could be misused — identity documents, share certificates, property papers, cheque books, passports. Most issuing authorities require the complaint number, and the complaint itself protects you if the document is misused before the duplicate is issued. - Some authorities additionally require publication of a notice in a newspaper before issuing a duplicate, particularly for share certificates and property documents. Check the requirement before applying. - Retain a copy of this affidavit, the police complaint and the newspaper publication, if any.