Fillable Printable General Affidavit of Loss
Fillable Printable General Affidavit of Loss
General Affidavit of Loss
AFFIDAVIT OF LOSS
(General)
Identification of Security: _________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
(Include group number, certificate number, face amount, coupon rate, and maturity date)
Whereas, Federal Home Loan Mortgage Corporation issued the undersigned its _______________________________________________________________
_______________________________________________________________________________________________________________________________
(Name of security)
as evidenced on the books of the Federal Home Loan Mortgage Corporation or its Fiscal Agent, and whereas the investment certificate has been lost or
destroyed and the undersigned desires to obtain a duplicate;
Therefore, the undersigned hereby makes this affidavit to induce said Federal Home Loan Mortgage Corporation to issue such duplicate certificate and make
oath that:
(1) Said ______________________________________________________________________________________________________________
(Name of security) was issued to the undersigned and is still owned by the undersigned,
(2) said certificate has never been pledged or sold or transferred by the undersigned and is not subject to any kind of lien or
claim of any other entity, and
(3) undersigned further says that the certificate has been lost or destroyed and after diligent search cannot be located;
Wherefore, in consideration of the issuance of the duplicate certificate the undersigned hereby agrees to indemnify and hold the said Federal Home Loan
Mortgage Corporation and its Fiscal Agent harmless against any loss, damage, or expense on account of the issuance of such duplicate, or on account of any
claim of any other to or upon said certificate and the undersigned further agrees that in the event of the discovery of said original certificate to promptly deliver
the same to the Federal Home Loan Mortgage Corporation.
Dated this _____________________________________ day of _____________________________________, 20_________,
________________________________________________
(Signature)
________________________________________________
Title and Name of Company (if applicable) [Apply Corporate Seal]
Individual Acknowledgement
State of ____________________________________________
County of ____________________________________________
On this ____________________________________________ day of ______________________________________, 20 _________,
before me personally appeared ______________________________________________________________________________________
_____________________________________________, to me known and known to me to be the person described in and who executed the foregoing
instrument, and he duly acknowledged to me that he executed the same.
[Notarial Seal] ____________________________________________
(Notary Public)
My Commission Expires: _______________________
Corporate Acknowledgement
State of ____________________________________________
County of ____________________________________________
On this ____________________________________________ day of ______________________________________, 20 _________,
before me personally appeared _________________________________________________________________________ to me known, who being by me
duly sworn, did depose and say: that he resides at ____________________________________________________________________________________
that he is the _______________________________________of ___________________________________________ the corporation described in and which
executed the foregoing instrument; that he knows the seal of said corporation; that the seal affixed to said instrument is such corporation seal; that it was so
affixed by order of the Board of Directors of said corporation; and that he signed his name thereto by like order.
[Notarial Seal] ____________________________________________
(Notary Public)
My Commission Expires: _______________________
