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AFFIDAVIT OF LOST DOCUMENT
I, ______, of ______, in the Province of Ontario, MAKE OATH AND SAY that:
I was the holder of the following document: ______ (reference number: ), issued by .
I last had the document in my possession on or about .
The document was lost in the following circumstances: ______.
The document has not been pledged, sold, or transferred by me to any other person, and I have made diligent efforts to locate it without success.
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