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Statutory Declaration of Loss of a Receipt
A sworn declaration that a receipt has been lost — used to support a claim, reimbursement, warranty, or expense where the original receipt is unavailable. Fill it in online, download a ready-to-sign PDF, and notarize in Ontario.
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Word files are editable. Review any changes carefully before signing or uploading.
Also known as
- Lost Receipt Affidavit
- Declaration of Lost Receipt
- Missing Receipt Declaration
+1 more names
- Sworn Statement of Lost Receipt
STATUTORY DECLARATION OF LOSS OF A RECEIPT
I, ______, of ______, in the Province of Ontario, SOLEMNLY DECLARE that:
On ______, I paid ______ to ______ for ______.
The receipt or proof of payment was lost in the following circumstances: ______.
I have made diligent efforts to locate it without success, and the payment described above was genuinely made.
Purpose of this declaration (if specified):
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.
Signed and sworn (or affirmed/declared) before me by videoconference in Ottawa, Ontario, while the Affiant(s)/Declarant(s) were located in ______________________, on ______________________, pursuant to O. Reg. 431/20, and Electronic Commerce Act, 2000.
______________________________ | ______________________________ |
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- General template, not legal advice
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Statutory Declaration of Loss of a Receipt
A compact preview of this template
01Your Information
Your full legal name
What the payment was for
Your full address
STATUTORY DECLARATION OF LOSS OF A RECEIPT
I, ______, of ______, in the Province of Ontario, SOLEMNLY DECLARE that:
On ______, I paid ______ to ______ for ______.
The receipt or proof of payment was lost in the following circumstances: ______.
I have made diligent efforts to locate it without success, and the payment described above was genuinely made.
Purpose of this declaration (if specified):
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.
Signed and sworn (or affirmed/declared) before me by videoconference in Ottawa, Ontario, while the Affiant(s)/Declarant(s) were located in ______________________, on ______________________, pursuant to O. Reg. 431/20, and Electronic Commerce Act, 2000.
______________________________ | ______________________________ |
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Overview
About this document
- 01
What is a lost receipt declaration?
It is a sworn statement — also called a lost receipt affidavit — confirming that a receipt has been lost and describing the purchase or payment it related to.
It is used where you must support a claim or expense but cannot provide the original receipt.
- 02
When you might need one
It supports claims and reimbursements.
- Claiming an expense or reimbursement without the original receipt.
- Supporting a warranty or return where the receipt is lost.
- Confirming a purchase or payment for an insurer or employer.
- 03
What to include
Describe the purchase or payment — what, when, where, and the amount — and confirm the receipt has been lost and cannot be located. Keep any supporting records, such as a bank or card statement, available.
- 04
How to notarize a statutory declaration of loss of a receipt in Ontario
After you fill in your statutory declaration of loss of a receipt 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 statutory declaration of loss of a receipt 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.
Good to know
Before you fill it in.
Short notes from our notary on this template. Worth a minute before you start.
- 01
Reviewed for use in Ontario by a notary public and commissioner for taking affidavits.
- 02
Fill it in online for free and download a ready-to-sign PDF — no account required.
- 03
Sign in front of the notary, who administers your oath or affirmation and applies the seal.
- 04
Notarize online by video across Ontario, or in person in Ottawa.
Frequently asked
Questions about the Statutory Declaration of Loss of a Receipt
- When do I need a lost receipt declaration?
- To support a claim, reimbursement, warranty, or expense where the original receipt has been lost and cannot be produced.
- What should it include?
- A description of the purchase or payment — what, when, where, and the amount — and confirmation the receipt is lost.
- Can I notarize it online in Ontario?
- Yes. You can swear it online by video under Ontario’s remote commissioning rules, or in person in Ottawa with Minute Notary.
- Should I keep other records?
- Yes. Keep a bank or card statement or other proof, as the recipient may accept it alongside your declaration.
Keep exploring
Related templates
Other documents for identity & personal status.
- 01Statutory Declaration of Loss of Earnings
A sworn declaration of income you lost — used to support an insurance, accident, or compensation claim. Fill it in online, download a ready-to-sign PDF, and notarize in Ontario.
Fill it out - 02Statutory Declaration of Lost or Stolen Identification
A sworn declaration that a piece of government identification has been lost or stolen — often required before a replacement is issued. Fill it in online, download a ready-to-sign PDF, and notarize in Ontario.
Fill it out - 03Statutory Declaration of Non-Receipt
A sworn declaration that you did not receive goods, a payment, or an item you were expecting — useful to support a dispute, refund, reissue, or insurance claim. Fill it in online, download a ready-to-sign PDF, and notarize in Ontario.
Fill it out - 04Statutory Declaration of No Outstanding Debts
A sworn declaration that you have no outstanding debts of a stated kind — used to support a clearance, transaction, or application. Fill it in online, download a ready-to-sign PDF, and notarize in Ontario.
Fill it out
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Fill it in online, then download a ready-to-sign PDF or an editable Word copy. Use the generated PDF to continue to booking. Not sure what the appointment involves? Read about the Statutory Declarations service first.