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Affidavit Concerning Lost Check Form #399

Affidavit Concerning Lost Check Form #399 2025

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The document is an Affidavit Concerning Lost Check(s) form for NYCERS members and pensioners to report lost checks. It provides instructions on how to complete the form, options for receiving replacement checks (either by mail or direct deposit), and the necessary personal information required. The document emphasizes the importance of notarization and warns against providing false information.

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What does lost affidavit mean?

An Affidavit of Loss is a sworn statement executed by a person (the affiant) attesting to the loss, destruction, or unavailability of a document or property.

What is a check affidavit?

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.

How to write an affidavit of a lost document?

Sample Affidavit of Lost Document That I can no longer locate the original originally signed or produced ; That I made efforts to locate the document but all efforts to retrieve the said document have proved abortive; That I am in need of a certified true and correct copy of the document at this time.

What is a lost check affidavit?

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.

How do I write a lost affidavit?

Affidavit of Loss Template I am the lawful owner/holder of [Describe the lost item/document], bearing [Identification details/Serial number], issued on [Date of Issuance] by [Issuing Authority/Organization]. On [Date of Loss], I discovered that the said [Item/Document] was missing from my possession.

What is a declaration of loss for an official check?

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.

Affidavit Concerning Lost Check Form #399 2025

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