PDF Template
Lost or Stolen Check Affidavit
Download a blank template to fill in by hand
This template includes fields for:
- Full Legal Name
- State ID / Driver's License Number
- Who Issued the Check
- Bank the Check Was Drawn On
- Check Number
- Amount of the Check
- Date of the Check
- What Happened to the Check
- Details of the Loss
or
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1
Download and print
Download the PDF template and print it out on A4 paper.
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2
Fill in your details
Complete all the fields with a blue or black pen. Write clearly and legibly.
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3
Get notarized by a Notary Public
Take the completed form to any Notary Public. The Notary Public will verify your identity and witness your signature.
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4
Bring your ID
Remember to bring your government-issued ID or passport when going to get your affidavit notarized.