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Affidavit of Loss Template

An affidavit of loss is a sworn statement that something (an ID, an ATM card, a receipt) was lost, how, and that you could not find it. Offices usually ask for one before they replace what was lost. Answer a few questions, print it, and sign it in front of a notary.

Fill out Affidavit of Loss Free, no sign-up. Stays on your device.

A template, not a government form and not legal advice. GovForms is not a law firm. The wording follows the 2004 Rules on Notarial Practice.

Who needs it

  • Anyone replacing a lost ID, license, card or other document that asks for an affidavit
  • Anyone asked to explain a lost receipt, certificate or other record

What to have on hand

  • What was lost, with its number if it has one
  • When and where it was lost, and what happened
  • A valid ID with your photo and signature, for the notary
  • The notarial fee, which varies by notary

Missing something? Your answers save as you go, so you can finish later.

How it works

  1. Answer plain questions

    One section at a time, with hints for each item.

  2. Watch the document take shape

    A live preview shows the document typed out with your answers.

  3. Download and print

    A clean PDF, ready to print. Sign it in front of the notary, not before.

Questions

Do I need a police report too?

Some offices ask for one alongside the affidavit, especially for lost passports, plates and some cards. Check with the office that will replace what you lost.

What if the office has its own affidavit format?

Use theirs. Some offices and banks have their own format; this one is for when they don't.

Is it free?

Yes. GovForms is free to use, with no sign-up.

Is my information private?

Your answers are saved only in this browser, and the PDF is made on your device. GovForms never receives them.

Do I sign it before going to the notary?

No. Print it unsigned and sign it in front of the notary, with your ID. The notary fills in and signs the part at the end, so leave that blank.

Will a notary accept it?

Most will, but a notary can ask for changes or for their own format. This is a template, not legal advice, and GovForms is not a law firm. If property or a large amount of money is involved, have a lawyer look at it first.

More on privacy and our disclaimer.

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