web analytics

Lost Stock Certificate

Free Printable Lost Stock Certificate FormFree Printable Lost Stock Certificate Form

Lost Stock Certificate

If you lose your stock certificate, you still own the shares that you have made but in order to replace it, you must contact the company itself.

If you have a Lost Stock Certificate, you will need the affidavit. Filling out the affidavit of a lost stock certificate is relatively easy. What you need is to obtain the physical form after that, all you will need to do is fill it out. It will usually and generally contain the following:


  1. The state you are in
  2. The county
  3. Your name, swearing an oath that states your . . .
  4. Address or place of residence
  5. The description of the stock
  6. The owner of the stock


Within the legal written document, the terms of loss of stock certificate will be stated such as your efforts to relocate your certificate and a guarantee that you have lost it, and that no person, company, or security is to blame.


It also states that the affidavit is made solely for the purpose of the issuance of a new stock certificate in exchange for the one certificate that has been lost, destroyed, or stolen and that the original cannot be surrendered back to the company.


It finally states that the issued duplicate will be registered, countersigned, and that if the original certificate of stock is found, it is to be surrendered to the company


It will then be signed with the owner of the stock’s name, the date it was signed, and the signature of the notary public.


Lost Stock Certificate, Affidavit of

State of _______________
County of _____________

___________________, being first duly sworn on oath deposes and says that ___ is an adult and resides at _____________________.

1. The certificate(s) representing the following described shares of stock has been lost,
stolen or destroyed: ____________________________.

Registered owner’s exact name as it appears on the original certificate:
Issuer’s name:
Number of shares:

2.    The above-described stock is solely owned by ________________.

3.    That Affiant has made or caused to be made a diligent search for said securities and
has been unable to find or recover same.  Neither said securities nor any interest therein has been sold, assigned, endorsed, pawned, pledged for any bank or brokerage loan or otherwise, or disposed of in any manner by or on behalf of said owner.  Neither said owner nor anyone on said owner’s behalf has signed any power of attorney, any stock power, or other assignment or authorization respecting the same which is now outstanding and in force.  No person, firm or corporation has any right, title, claim, equity, or interest in, to, or respecting said securities, excepting the sole owner above named.

4.  That this affidavit is made for the purpose of inducing the issuance of a new or duplicate certificate in substitution of or in exchange for said lost, stolen or destroyed certificate without requiring the surrender of the original, or the payment, delivery, exchange, or credit in respect of such original without such surrender, and/or inducing to issue an indemnity bond.

5.  If such new or duplicate certificate(s) is so issued, countersigned and registered, or such payment, delivery, exchange or credit is made in respect of such original(s), then it is understood and Affiant hereby agrees that if said lost certificate comes into Affiant’s control or custody, the recovered stock certificate will be delivered to the issuer or, at issuer’s request, to issuer’s Transfer Agent, for the purpose of cancellation.

Owner of Stock

Acknowledgment:  Subscribed and sworn to before me this __day of ______, 20______.

Notary Public
My commission expires:

Download ODT Download DOC Download DOCX Download RTF Download PDF

Leave a Reply