Fill in Lost Document Affidavit (Passport / Share Certificate)

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Lost Document Affidavit (Passport / Share Certificate)

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LOST DOCUMENT AFFIDAVIT

I, __________, __________, resident of __________, holding __________, ordinarily resident within __________ (the "Deponent" or "I"), do hereby solemnly affirm and declare as follows:

1. THE DOCUMENT LOST

2. CIRCUMSTANCES OF LOSS

3. REPORT AND NOTICE

4. UNDERTAKING AND INDEMNITY

5. DECLARATION

5.1 Every statement made above is true to my own knowledge and belief, and I have concealed nothing material to this affidavit. I am aware that making a false declaration in an affidavit is an offence.

VERIFICATION

DEPONENT

Signature: ______________________________
__________

ATTESTATION

Notary Public / Oath Commissioner
Registration No. and seal: ____________________

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