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Affidavit of Loss for a Lost ATM or Debit Card

Many banks ask for a notarized affidavit of loss before they replace a lost ATM or debit card. Fill in the form below and the affidavit is written for you as you type.

What to prepare

  • Bank name and the branch where the account is kept
  • Last four digits of the card (never the full card number or PIN)
  • Date and place you noticed the card was missing
  • One valid government ID for the notary

Good to know for this situation

  • Call your bank's hotline to block the card first; the affidavit does not stop transactions.
  • Write only the last four digits of the card. A full card number on a paper document is a security risk.
  • Some banks only need a branch form for ATM cards and ask for an affidavit only for passbooks. Ask before paying a notary.

Template only, not legal advice. Checked 2026-11-11.

Questions

Do I need an affidavit of loss to replace an ATM card?
It depends on the bank. Some replace cards with only a branch form and ID; others require a notarized affidavit of loss. Requirements can differ by office and change over time, so confirm with the office that will receive the document before you have it notarized.
Should I write my full card number?
No. Use the last four digits and the account holder name. The bank can identify the card from that.

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