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Missing Receipt Affidavit Form

Complete this missing receipt affidavit online, download the fillable PDF, or print a blank copy. If you need a lost receipt form, use the same statement and check the recipient’s instructions before submitting.

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Missing receipt statement

Complete the fields that apply. Check the recipient’s instructions before submitting.

Fill in this browser · no upload

Transaction date

Amount and currency

Merchant, vendor, or payee

Expense or purchase type

Why is the receipt unavailable?

Lost Not received Damaged or unreadable Other

Business purpose or explanationUse factual details. Add an attachment separately if the recipient asks for supporting records.

StatementReview and edit this wording so it is true for your situation before signing.

Signature (type your full name)

Date signed

Company, program, or report (optional)

I reviewed the entries and statement, and they are accurate to the best of my knowledge.

This form runs in your browser. It does not send or store your entries on this site. Use the print dialog to print or save a PDF to your device.

When to use a missing receipt form

Use this template only when the recipient accepts a signed missing-receipt statement for the transaction. First check the employer, card program, reimbursement plan, or other recipient’s own instructions; a completed form does not itself establish that the recipient will accept it.

For one specific example, Ramp’s guidance describes affidavits in its own receipt workflow and says employees should try to obtain a replacement from the vendor first. Ramp also lists the vendor, date, amount, business purpose, and signed attestation among the information its process collects. Those are Ramp’s instructions, not a rule for every organization.

If the company does not accept this form: ask the expense administrator what alternative documentation is allowed and whether the vendor can issue a duplicate. Do not change the declaration to imply an approval you have not received.

Why policies differ

Organizations may use their own expense systems and documentation steps. Columbia University’s Concur job aid, for example, describes how its users add a Missing Receipt Declaration to eligible expense items and explains that its own original-receipt requirements vary by expense type. Follow the recipient’s current process rather than treating this blank template as an official company or university form.

This is a general record template, not a form issued by an employer, tax agency, bank, or expense platform. It does not state a legal requirement, promise reimbursement, or replace the recipient’s approval process.

Official process references

Ramp, “How do missing receipt affidavits work?” — Ramp-specific workflow and fields. Checked November 9, 2026. Read Ramp’s guidance.

Columbia University Finance Training, “Adding a Missing Receipt Declaration to a Concur Expense Item Job Aid” — Columbia-specific process and receipt requirements; page lists its last revision as May 2026. Checked November 9, 2026. Read the job aid.