Affidavit of Loss of Bill of Lading with Agreement to Hold Harmless
STATE OF ____________________
COUNTY OF _______________________
PERSONALLY appeared before me, the undersigned authority in and for said
county and state, (Name of Affiant), who, having been being first duty sworn by the
undersigned Notary Public, deposes and says:
1. Affiant, being (number) years of age, resides at (street address, city, state, zip
2. Affiant is the original (consignee or consignor) named in Bill of Lading No.
(number), dated (date), issued by (name of issuer).
3. On or about (date), Affiant discovered that the above mentioned document was
(lost, destroyed or stolen) in the following manner: (description of events of loss).
4. Affiant requests delivery o