Fill and Sign the Bill Lading 497331665 Form

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 code) . 2. Affiant is the original ______________ (consignee or consignor) named in B ill of Lading N o. ________ (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 of the goods covered by the document even though surrender of the document has not been made. Affiant agrees to hold harmless and indemnify _________________ (name of carrier) and any person who suffers loss, damage, or injury by delivery of the goods arising out of the delivery with non-surrender of the document. ___________________________________ (Printed Name of Affiant) ___________________________________ (Signature of Affiant) SWORN to and subscribed before me, this the ____ day of _____________, 20____. _____________________________ NOTARY PUBLIC My Commission Expires: ___________________