How do I complete this lost instrument affidavit?

Enter the account and institution details, state that the passbook or other instrument cannot be located, name the requested payee, then sign before a notary and submit the completed affidavit.

Do I need to sign the affidavit in front of a notary?

Yes. The form includes a subscribed-and-sworn jurat, so the claimant must sign and swear to the affidavit before a notary.

Can I use an online notary for this affidavit?

A commissioned online notary can conduct a notarization by video, but confirm acceptance with the receiving agency before booking. Confirm with the receiving agency or the Recorder of Deeds if unsure.

What does the affidavit ask me to promise?

The form asks the claimant to indemnify the Administrator for losses from relying on the affidavit and to repay related claims, costs, and expenses. It also says the affidavit binds the claimant’s heirs, executors, administrators, and assigns.

Office of the Lieutenant Governor, VI · St. Thomas

Affidavit of Lost Instrument

This affidavit lets an account owner report a missing passbook or other instrument and request payment of presumed-abandoned funds held in trust by the Administrator.

Simple form~10 min to notarize

licensed online notary
~15 min average
Notarized PDF emailed

What you’ll need

Government-issued photo ID
Webcam-enabled device (laptop or phone)
This form, ready to upload as a PDF

Form previewView full PDF →

What this form is

The Affidavit of Lost Instrument is for a claimant who says they own an account held in trust by the Administrator and cannot locate its passbook or other instrument. The claimant identifies the account, requests payment to a named recipient, and agrees to cover losses or claims arising from the Administrator’s reliance on the affidavit. Submit it when making a claim for funds held in trust.

Who needs it

An account owner seeking funds held in trust by the Administrator may use this affidavit when the account’s passbook or other instrument cannot be located.

Why it needs a notary

The form has a subscribed-and-sworn jurat stating it was sworn to before a notary; the claimant signs the affidavit before the notary.

How to get this notarized

1
Download The Affidavit
Get the Affidavit of Lost Instrument from the Office of the Lieutenant Governor.
2
Fill In The Account Details
Provide the account type, number, institution, amount, and requested payee; review the statements and indemnity terms.
3
Book An Online Notary
Confirm the receiving agency accepts online notarization, then schedule a session with a commissioned online notary.
4
Sign On Video
Sign and swear to the affidavit during the online notary session; complete the notary details as directed.
5
Submit The Affidavit
Send the completed, notarized affidavit to the receiving agency handling the funds claim.

Preview the form

The blank PDF straight from Office of the Lieutenant Governor. Look it over, then upload your filled copy to start the notary session.

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You’ll need ID and a webcam.

A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.