Affidavit of loss check sample 2025

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Affidavit of Lost Payroll Check/Certificate of Indemnity Use this form when a payroll or off-cycle check/EFT(Direct Deposit) has been lost, stolen or destroyed. Use when an off cycle check is created with no stop payment put in place.
Contact your financial institutions fraud department and explain what happened. Theyll most likely ask you to complete an Affidavit of Check Fraud. This is a legal document that states the check was forged. In most cases, this form must be notarized by a Notary Public.
Affidavits can be useful in many situations. Many government forms include affidavits, such as drivers license applications, vehicle registrations, voter registrations, and concealed weapon permits. Affidavits are also common in various legal proceedings, especially when a witness is not available to appear in court.
Draft or Obtain a Template You can draft your own affidavit, or you may use a ready-made template often provided by law offices or notarial services. Ensure it includes all the essential details: your name, address, citizenship, the item lost, and the exact circumstances of how and when it was lost.
Download Replacement Check Affidavit Form (PDF) This form is also known as the Declaration of Lost or Destroyed Payroll Check and is used to replace a lost, damaged or stale dated paycheck.
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This declaration is an affidavit or other writing made under penalty of perjury alleging the loss, destruction, or theft of the check and stating that the declarer is a person entitled to assert a claim, i.e. the drawer or payee of a certified check or the remitter or payee of a cashiers check or tellers check.

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