Lost Bank Card
Declare the loss or theft of your debit card, credit card, or ATM card. This sworn statement can support fraud dispute claims with your bank or credit card issuer and documents the circumstances of the loss for your financial protection under federal consumer protection laws.
Prefer to fill in by hand?
Download a blank PDF template to print and complete manually.
Download Blank TemplateLost Bank Card Affidavit — Frequently Asked Questions
How do I make a lost bank card affidavit legally valid?
Fill in the lost bank card affidavit, print it, and sign it in front of a Notary Public — do not sign beforehand. Bring a valid government-issued photo ID. Notaries are available at UPS Stores, banks, law offices, courthouses, and through online notarization services, and fees typically range from $2 to $25 per signature depending on your state.
Is this lost bank card affidavit template free?
Yes. You can generate a completed lost bank card affidavit PDF or download a blank printable template completely free, with no sign-up required. Your information is used only to generate the document and is not stored after the PDF is created.