Affidavit Of Loss
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AFFIDAVIT OF LOSS
I, [SPECIFY NAME], domiciled and residing at [YOUR COMPLETE ADDRESS], do hereby solemnly declare that:
I am the
[
TITLE
]
of
[
COMPANY
]
and as such have knowledge of the facts herein declared.
[
COMPANY
]
, a wholly-owned subsidiary of
[
SPECIFY
COMPANY]
, executed a Trust Deed of Hypothec bearing formal date of
[DATE]
in
favor
of
[SPECIFY]
. (“
SPECIFY
”), which deed was registered at the Registry Office in and for the Registration
Division of
[SPECIFY PLACE]
on
[DATE]
under the number
[NUMBER]
(the “Trust Deed”).
[
SPECIFY
COMPANY
]
issued a
[
%
]
mortgage bond certificate number
[NUMBER]
in the principal amount of
[AMOUNT]
in legal currency of
[COUNTRY]
(the “Bond”) pursuant to the Trust Deed, which Debenture
[
SPECIFY
COMPANY
]
then pledged in
favor
of
[
SPECIFY
COMPANY
]
on
[DATE]
, 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).
[
SPECIFY
COMPANY
]
assigned the indebtedness of
[
SPECIFY
COMPANY
]
which the Trust Deed was executed and the Bond issued and pledged to secure (the “Indebtedness”) to
[
SPECIFY
COMPANY
]
(“
COMPANY
”) pursuant to an Agreement of Absolute Assignment dated as of
[DATE]
by and between
[
SPECIFY
COMPANY
]
and
[
SPECIFY
COMPANY
]
(the “Assignment”) (a copy of which is attached hereto).
[
SPECIFY
COMPANY
]
has received the Bond, but has lost same, and although
[
SPECIFY
COMPANY
]
has made a due and diligent search
therefore
,
[
SPECIFY
COMPANY
]
has been unable to find the Bond.
Said Bond has not been endorsed by
[
SPECIFY
COMPANY
]
, save and e
xcept for the endorsement to [SPECIFY]
as of
[DATE]
(the “Endorsement”) pursuant to the Assignment (a copy of the Endorsement is attached hereto). Save and except for the Assignment and Endorsement,
[
SPECIFY
COMPANY
]
has not executed or signed any other instrument of transfer in connection with the Bond or the Indebtedness, nor has
[
SPECIFY
COMPANY
]
otherwise sold, assigned, transferred, pledged, hypothecated or in any way encumbered or disposed of the Bond or the Indebtedness or any rights therein.
[
SPECIFY
COMPANY
]
hereby accordingly requests
[
SPECIFY
]
to issue a new mortgage bond certificate to
[
SPECIFY
COMPANY
]
in replacement of the Bond lost and assigned to
[
SPECIFY
COMPANY
]
.
I have executed this Affidavit of Loss in support of
[
SPECIFY
COMPANY
]
’s request that a new mortgage bond certificate be issued to
[SPECIFY COMPANY]
by
[SPECIFY]
.
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
or equivalent