AFFIDAVIT OF LOSS

I, [Your Full Name], of legal age, residing at [Your Address], do hereby solemnly affirm and declare under penalty of perjury that:

1. I am the lawful owner of the [Lost Item] described as [Description of Lost Item].

2. On [Date of Loss], I discovered that the said [Lost Item] was lost or misplaced.

3. Despite diligent efforts to locate the [Lost Item], I have been unable to recover it.

4. I hereby declare that the loss of the [Lost Item] was not due to any negligent or intentional act on my part.

5. I have not assigned, sold, transferred, or pledged the [Lost Item] to any person or entity.

6. I am executing this affidavit to attest to the truth of the foregoing statements and to request the necessary actions to be taken regarding the loss of the [Lost Item].

IN WITNESS WHEREOF, I have hereunto set my hand this [Date] at [City, Province].

______________________
[Your Full Name and Signature]

SUBSCRIBED AND SWORN to before me this [Date] at [City, Province].

______________________

[Notary Public]

Doc. No. _____;
Page No. _____;
Book No. _____;
Series of [Year].