AFFIDAVIT OF LOSS
I, [SPECIFY NAME], domiciled and residing at [YOUR COMPLETE ADDRESS], do hereby solemnly declare that:
I am the
and as such have knowledge of the facts herein declared.
, a wholly-owned subsidiary of
, executed a Trust Deed of Hypothec bearing formal date of
”), which deed was registered at the Registry Office in and for the Registration
under the number
(the “Trust Deed”).
mortgage bond certificate number
in the principal amount of
in legal currency of
(the “Bond”) pursuant to the Trust Deed, which Debenture
then pledged in
, and which ple
dge was registered by [SPECIFY]
in the register kept for such purpose, as per the trustee’s attestation on the reverse of the Bond (a photocopy of which is attached hereto).
assigned the indebtedness of
which the Trust Deed was executed and the Bond issued and pledged to secure (the “Indebtedness”) to
”) pursuant to an Agreement of Absolute Assignment dated as of
by and between
(the “Assignment”) (a copy of which is attached hereto).
has received the Bond, but has lost same, and although
has made a due and diligent search
has been unable to find the Bond.
Said Bond has not been endorsed by
, save and e
xcept for the endorsement to [SPECIFY]
(the “Endorsement”) pursuant to the Assignment (a copy of the Endorsement is attached hereto). Save and except for the Assignment and Endorsement,
has not executed or signed any other instrument of transfer in connection with the Bond or the Indebtedness, nor has
otherwise sold, assigned, transferred, pledged, hypothecated or in any way encumbered or disposed of the Bond or the Indebtedness or any rights therein.
hereby accordingly requests
to issue a new mortgage bond certificate to
in replacement of the Bond lost and assigned to
I have executed this Affidavit of Loss in support of
’s request that a new mortgage bond certificate be issued to
DATED this [DAY] day of [MONTH, YEAR].
AND I HAVE SIGNED
SOLEMNLY DECLARED before me
at [SPECIFY place] this [DAY] day
of [MONTH, YEAR]
Commissioner for Oaths, Notary Public,
Solicitor authorized to administer oaths