Affidavit of Non-Receipt: Meaning, Purpose, and Sample Form
An Affidavit of Non-Receipt is a sworn statement declaring that an individual did not receive a particular item, document, payment, notice, package, or any material that was expected or claimed to have been delivered. This affidavit is commonly used to clarify delivery disputes, resolve administrative issues, support claims, or correct official records.
It is often required by government agencies, banks, employers, courier services, schools, and private institutions to verify claims of non-receipt. Because this affidavit is executed under oath, all statements must be truthful and based on personal knowledge to avoid legal consequences.
When Is an Affidavit of Non-Receipt Needed?
This affidavit may be required when:
- You did not receive a salary, payment, or allowance.
- A document, notice, or letter did not reach you.
- A package, delivery, or courier item failed to arrive.
- You did not receive an official ID, certificate, or record.
- A bank deposit or financial transaction was not received.
- An office or institution claims to have sent something, but you never got it.
Supporting evidence such as screenshots, emails, tracking numbers, or payment records may be required depending on the institution.
What Should Be Included in an Affidavit of Non-Receipt?
A complete Affidavit of Non-Receipt should contain:
- Affiant’s full name, age, address, and personal details.
- Description of the item or payment not received.
- Relevant reference details: tracking number, document name, amount, date sent, etc.
- Clear declaration that the affiant did not receive the item.
- Purpose of issuing the affidavit.
- Affiant’s signature and notarization block.
The statement must be clear, factual, and specific to avoid misinterpretation.
Sample Affidavit of Non-Receipt (Editable Template)
Below is a clean, professional, and editable affidavit template. Replace all bracketed items with your details before printing and notarization.
REPUBLIC OF THE PHILIPPINES
[CITY / MUNICIPALITY]
[PROVINCE]
AFFIDAVIT OF NON-RECEIPT
I, [FULL NAME OF AFFIANT], of legal age, [citizenship], [civil status], and residing at [complete address], after being duly sworn according to law, hereby depose and state:
1. That the following item/document/payment was expected to be delivered or received by me: [describe the item or payment].
2. That according to [name of institution, sender, company], the item/document/payment was allegedly sent or delivered on [date], with the following details:
• Reference/Tracking/Document Number: [details]
• Amount/Type of Document/Package: [details]
• Expected Date of Receipt: [details]
3. That despite such claim, I categorically state that I have not received the said item/document/payment up to the present date.
4. That I am executing this Affidavit of Non-Receipt to clarify the matter and to comply with the requirements of [agency/company/bank/school/etc.] for documentation, replacement, investigation, or any legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this [day] day of [month, year] at [place of execution].
_________________________________
[FULL NAME OF AFFIANT]
Affiant
SUBSCRIBED AND SWORN to before me this [day] day of [month, year] at [place], the affiant presenting his/her valid government-issued ID:
ID Type and No.: [ID type and number]
Date & Place of Issuance: [details]
_________________________________
NOTARY PUBLIC
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of _____.
Disclaimer: This template is for general guidance only. Requirements may vary by institution. Consult a lawyer for specific legal advice.