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SAMPLE AFFIDAVIT OF LOST STOCK CERTIFICATE
1. I am of legal age, and
2. The Original Certificate(s) have been
4. The Original Certificate(s) were
5. None of the Original Certificate(s), or the Shareholder's rights in them, have, in whole or in part, been assigned, transferred, hypothecated, pledged, gifted, or otherwise disposed of in any manner whatsoever.
6. The Shareholder is entitled to the full and exclusive possession of the Original Certificate(s), and no other person or entity has any interest in the Original Certificate(s) or the proceeds from those.
7. If the Shareholder ever locates the Original Certificate(s), or if they are otherwise returned to the Shareholder, the Shareholder agrees that such Original Certificate(s) have no value and that it will surrender those recovered Original Certificate(s) to the Company immediately and without consideration for cancellation.
8. The Shareholder hereby requests and is making this affidavit for the purpose of requesting the Company to issue new or duplicate stock certificates in substitution for the Original Certificate(s).
[SIGNATURE PAGE FOLLOWS]
The Shareholder is signing this affidavit on the date set forth below.
Subscribed and sworn to before me this ____ day of _______, 20___, at _______, ____________.
Signature of Notary Public
Name of Notary Public: ______________________________________________ (SEAL)
Notary Public, State of
My commission expires: ____________________
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Here's the info you'll need to have handy to complete your doc:
Who it's coming from
Know for whom this document is being signed and where.
Be able to describe how the stock certificates were lost or destroyed.
Have the name of the company handy, as well as the par value and type of stock certificates being discussed.
What's an affidavit of lost stock certificate?
It happens. Sometimes stock certificates get lost or are accidentally destroyed. But don’t worry. Whether you plan to keep, sell, or transfer your stock, there is a way to recover the physical certificates. The company or transfer agent will replace them, but first they will require you to provide a verified, sworn statement known as an affidavit of lost stock certificate.