Affidavit Supporting Claim of Non-Delivery
I located in the State or Province of at
hereby certify that the information provided in this claim and the associated ID
verification request is true and correct to the best of my knowledge. I also certify that I
am making this request to assist in the processing of my claim related to accounts for
which I am the sole owner and user.
Per terms of the shipping arrangement on items were deemed delivered.
However, contrary to the terms of the shipping arrangement, the item was not delivered,
and the Recipient has not received it.
Recipient understands that states the item was delivered, Recipient
believes this to be inaccurate.
I understand that providing this information along with the ID verification request is
important and necessary to fulfill the processing of my claim, and failure to provide the
correct information could be a violation of the law.
Signed under penalty of perjury laws on this date .
Signature of Recipient _______________________
Printed Name of Recipient
