Lost or Stolen Check Affidavit
Declare under oath that a check issued to you was lost, stolen, destroyed, or never received, so the issuer or bank can place a stop payment and reissue the funds. Commonly required by banks, employers for lost paychecks, insurance companies, and government agencies before replacing an outstanding check.
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Download a blank PDF template to print and complete manually.
Download Blank TemplateLost or Stolen Check Affidavit Affidavit — Frequently Asked Questions
How do I get a lost paycheck or check reissued?
Contact the issuer — your employer, the insurance company, or the agency — and report the check as lost or stolen. Most issuers require a notarized lost check affidavit before placing a stop payment on the original and cutting a replacement, and some also charge the stop payment fee or impose a short waiting period.
What happens if someone cashes a check that was stolen from me?
If a stolen check was cashed with a forged endorsement, the payee generally is not responsible for the loss. Report it to the issuer and the bank promptly, complete a lost or stolen check affidavit and, if requested, an affidavit of forgery, and file a police report so the banks can pursue recovery from whoever negotiated the check.
How do I make a lost or stolen check affidavit affidavit legally valid?
Fill in the lost or stolen check affidavit 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 or stolen check affidavit affidavit template free?
Yes. You can generate a completed lost or stolen check affidavit 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.