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Affidavit Of Loss Of Share Certificate
AFFIDAVIT OF LOSS OF SHARE CERTIFICATE
[Name of affiant], being first duly sworn, deposes and says:
1. I am the sole and absolute owner of [Number of shares] shares of, which shares are represented by share certificate number [Certificate Number].
2. I have not sold, transferred, assigned or hypothecated said shares or in any other way divested myself or been divested of the ownership thereof.
3. Share certificate number has been lost, destroyed, or misplaced, through inadvertence or otherwise, and after making a diligent search of my records, I am unable to locate it.
4. I make this affidavit for the purpose of inducing the issuance of credit of the face amount of same without surrender thereof for cancellation.
Signature
Sworn to and subscribed before me, this [Date signed].
My Commission Expires:
Notary Public