Get Affidavit Of Loss Sample

E Company : Company Contact: Address: City, State Zip: RE: AFFIDAVIT OF LOST OR MISPLACED CERTIFICATE OF AUTHORITY To Whom It May Concern: This Department has been notified of the loss of the Certificate of Authority issued by this Department to Sample Insurance Company. An Affidavit of Lost or Misplac ed Certificate of Authority must be filed with this Department before a replacement Certificate of Authority will be issued. 1. The Affidavit must be completed and signed by a principal officer.

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