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A sworn affidavit that a cheque, bank draft, or money order has been lost — often required before the issuer will stop payment and reissue it. Fill it in online, download a ready-to-sign PDF, and notarize in Ontario.
Word files are editable. Review any changes carefully before signing or uploading.
Also known as
AFFIDAVIT OF LOST CHEQUE OR BANK DRAFT
I, ______, of ______, in the Province of Ontario, MAKE OATH AND SAY that:
A ______ (number ) in the amount of ______, issued by ______ and payable to ______, was issued on or about .
It was lost in the following circumstances: ______.
The instrument has not been cashed, endorsed, or transferred by me, and I have been unable to locate it.
I request that the issuer stop payment and reissue it, and I will return the original if it is found.
I make this solemn declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath.
SWORN / DECLARED before me at the ______________________ of ______________________, in the Province of Ontario, this ______ day of ______________, 20______.
_______________________________ _______________________________
A Commissioner for taking Affidavits Signature of Declarant
Affidavit of Lost Cheque or Bank Draft
A compact preview of this template
Your Information
Your full legal name
Type of instrument lost
Your full address
AFFIDAVIT OF LOST CHEQUE OR BANK DRAFT
I, ______, of ______, in the Province of Ontario, MAKE OATH AND SAY that:
A ______ (number ) in the amount of ______, issued by ______ and payable to ______, was issued on or about .
It was lost in the following circumstances: ______.
The instrument has not been cashed, endorsed, or transferred by me, and I have been unable to locate it.
I request that the issuer stop payment and reissue it, and I will return the original if it is found.
I make this solemn declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath.
SWORN / DECLARED before me at the ______________________ of ______________________, in the Province of Ontario, this ______ day of ______________, 20______.
_______________________________ _______________________________
A Commissioner for taking Affidavits Signature of Declarant
How it works
Answer the questions, choose the download you need, then continue with signing or booking.
Overview
It is a sworn statement — also called a lost cheque affidavit or lost instrument affidavit — confirming that a negotiable instrument has been lost and has not been cashed, endorsed, or transferred.
Banks rely on it before stopping payment and reissuing the instrument.
It supports reissuing a lost instrument.
Describe the instrument — type, number, amount, issuer, and payee — and how and when it was lost, and confirm it has not been cashed, endorsed, or transferred. Each bank has its own process and may require an indemnity in addition to the affidavit.
After you fill in your affidavit of lost cheque or bank draft and download the PDF, do not sign it in advance. A sworn document must be signed in front of a notary public or commissioner for taking affidavits, who administers your oath or solemn affirmation first.
Minute Notary commissions your affidavit of lost cheque or bank draft online by secure video, under Ontario's remote commissioning rules (O. Reg. 431/20), or in person in Ottawa. Bring valid government-issued photo identification so we can verify your identity before applying the notary seal.
Frequently asked
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