Loss Document Affidavit

THIS LOSS DOCUMENT AFFIDAVIT is executed on [execution_date] at [place]

 

BETWEEN

[party1_name], resident of [party1_address] (First Party)

 

AND

 

[party2_name], resident of [party2_address] (Second Party).

 

The parties hereby agree to the terms recorded in this Loss Document Affidavit on the date above.

 

IN WITNESS WHEREOF the parties have signed this Loss Document Affidavit on the day and year first above written.

 

_________________________ _________________________

First Party Second Party