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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.
Word files are editable. Review any changes carefully before signing or uploading.
Also known as
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.
I make this declaration for the following purpose: .
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
Statutory Declaration of Loss of a Receipt
A compact preview of this template
Your 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.
I make this declaration for the following purpose: .
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 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.
It supports claims and reimbursements.
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.
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.
Frequently asked
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