Affidavit for Lost Stolen or Destroyed Stock Certificate

An Affidavit for Lost Stolen or Destroyed Stock Certificate sample form. Reportedly, there are more than 50 million paper stock certificates in circulation. 

But for me circulation means that they're tucked away in cardboard boxes under my bed, pushed to the back of a closet, or stored in the garage.

Consequently, I either misplace or lose some from time to time and have to replace them and when I do I have to complete an affidavit of lost stock the one below.




State of ______________________

County of _____________________


I, [name] , being duly sworn, state:

That I reside at   [address] ,   [city],  [state] 

That I am the legal and beneficial owner of    [number] shares of the    [specify class] stock of [corporation] represented by certificates described as follows:

Number                 Date                Registered Name

That said certificates     [were or were not]    endorsed.

That I have not assigned, hypothecated, pledged, or in any other way disposed of either the stock certificates or my rights as a stockholder, in whole or in part.

That I am entitled to full and exclusive possession of said certificates.

That the circumstances surrounding the    [loss, or theft, or destruction, or disappearance]   of said certificates and my attempt to locate them are as follows:

That the purpose of preparing this affidavit is to induce [corporation]   to issue new certificates to replace those that have been [lost, stolen, destroyed].

I hereby agree to surrender to [corporation] the original certificates issued to me should they hereafter come into my possession or control.






Related Pages
General Affidavit Form
Affidavit of No Lien
Notice of Intent to Exercise Warehouse Lien by Auction Form

Other Pages You Might Like
Offer to Special Order Merchandise Not in Stock
Apology and Request for Extension of Time to Deliver Goods
Apology and Replacement of Damaged Goods

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