The Affidavit for Loss of Certificate is a crucial document used when original certificates (such as stock certificates, academic credentials, or bond certificates) are lost, stolen, or destroyed. This affidavit serves as a formal declaration under oath, providing legal protection for both the certificate holder and issuer. It includes specific details about the lost certificate, circumstances of loss, and steps taken to locate it. The document is particularly important in the United States, where it must comply with state-specific requirements, UCC regulations, and federal securities laws when applicable. It typically includes an indemnification clause protecting the issuer against potential claims arising from the lost certificate's misuse.
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1. Affiant Information: Full legal name, address, and contact details of the person making the affidavit
2. Certificate Details: Comprehensive information about the lost certificate including certificate number, type, date of issuance, face value, and issuing authority
3. Circumstances of Loss: Detailed explanation of how and when the certificate was lost, stolen, or destroyed, including the last known location
4. Search Declaration: Statement describing all efforts made to locate the missing certificate
5. Indemnification: Legal statement promising to indemnify and hold harmless the issuing authority against any claims or liabilities
6. Verification: Statement confirming the truth of all information provided under penalty of perjury
1. Police Report Reference: Details of any police reports filed in case of theft or suspected theft
2. Witness Statement: Statements from any witnesses who can corroborate the loss circumstances
3. Insurance Claim Information: Details of any insurance claims filed related to the lost certificate
4. Previous Transactions: History of any relevant transactions or transfers related to the certificate before its loss
1. Schedule A - Identification Documents: Copies of government-issued identification documents of the affiant
2. Schedule B - Certificate Documentation: Any available copies or records of the lost certificate
3. Schedule C - Supporting Documents: Additional documentation such as police reports, insurance claims, or correspondence regarding the loss
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