Lost Document Affidavit Format (Lost Certificate, Bond or Card)
To issue a duplicate certificate, policy bond, share certificate or card, the issuer usually asks for an affidavit describing the loss, a police lost-article report, and sometimes an indemnity bond.
When you need this affidavit
- Duplicate insurance policy bond.
- Duplicate marksheet or degree certificate.
- Duplicate share certificate or deposit receipt.
- Lost passport, along with the passport office’s own process.
Lost Document Affidavit format
Non-judicial stamp paper or e-stamp certificate of value Rs. ______________ as applicable in the State of ______________
E-stamp certificate No. ______________ Date of issue ______________
Stamp duty depends on the State and the type of document. Confirm the correct value before printing.
AFFIDAVIT FOR LOSS OF DOCUMENT
I, Anjali Verma, D/o Shri Rajesh Verma, aged about 29 years, by occupation Service, residing at House No. 21, Sector 15, Rohini, Delhi 110089, do hereby solemnly affirm and declare as under:
- That I was the holder of the original LIC policy bond, Policy No. XXXX5678.
- That the said document was lost on or about 3 September 2026 while travelling by bus from Rohini to Karol Bagh, and despite a diligent search it could not be found.
- That I have reported the loss vide Lost Article Report No. LR-2026-001234 dated 4 September 2026 lodged online with Delhi Police.
- That I have not pledged, transferred or deposited the said document with any person or institution.
- That I am making this affidavit for issue of a duplicate policy bond, and if the original is found I shall return it to the issuing authority.
DEPONENT
VERIFICATION
Verified at Delhi on 14 October 2026 that the contents of paragraphs 1 to 5 of this affidavit are true and correct to the best of my knowledge and belief, and nothing material has been concealed therefrom.
DEPONENT
Solemnly affirmed / sworn before me by the deponent, who is identified to me, on ______________
Notary Public / Oath Commissioner: name ______________ Registration No. ______________
Seal and signature ______________
Drafting note: Banks, insurers and passport offices often have their own indemnity or affidavit forms for duplicates. Ask for them first.
Registration, if required: Sub-Registrar office ______________ Document No. ______________
How to fill it
| Field | What to write | Tip |
|---|---|---|
| Document | Name and number. | Mask long numbers. |
| When and where | Approximate date and place of loss. | Be specific. |
| Police report | Report number and date. | Many States allow online lost-article reports. |
| Purpose | Duplicate issue. | Name the issuer. |
Getting it sworn
- Print on stamp paper if requiredMany offices want affidavits on non-judicial stamp paper or with an e-stamp certificate; the value depends on the State and the office. Some accept plain paper. Ask first.
- Do not sign at homeSign only in front of the notary or oath commissioner, who checks your identity and records the oath or affirmation.
- VerificationThe verification paragraph at the end confirms the contents are true. It is dated and placed, and you sign again under it.
- Collect the attested copyThe notary affixes seal and signature and enters it in the register. Keep photocopies.
Frequently asked questions
Do I also need an indemnity bond?
Often yes for financial documents. See the indemnity bond format.
Is a police report necessary?
Most issuers ask for it. Online lost-article reports are available in many States.
Please note: these templates are for general information and are not legal advice. Laws, stamp duty, notarisation and registration rules vary by State. Consult an advocate for your case. This is an independent website, not a law firm and not a government office.