Affidavit of Non-Receipt of Payment Outline

I. Affidavit Information

I, [YOUR NAME], of [YOUR COMPANY NAME], residing at [YOUR COMPANY ADDRESS], being of sound mind and lawful age, hereby declare and affirm under oath that I have not received the payment from the following individual/entity:

• Payer Name: Pearl Bergna

• Amount Due: $5,000.00

• Payment Due Date: August 15, 2050

• Payment Method: Bank Transfer

II. Statement of Non-Receipt

I assert that as of today, December 10, 2050, I have not received the payment of $5,000.00 that was due on August 15, 2050, from Pearl Bergna. I have verified my accounts and records, and there is no evidence of this payment being processed or received through any channel. I have made reasonable efforts to contact Pearl Bergna and clarify this issue but have not received a satisfactory resolution or confirmation of the payment's completion.

III. Relevant Details of the Transaction

Below are the relevant transaction details for the payment in question:

Despite the payment being due on August 15, 2050, I have not received any funds in my account or any notification of payment completion.

IV. Conclusion and Signature

I declare under penalty of perjury that the foregoing statements are true and correct to the best of my knowledge and belief.

Executed on December 10, 2050.

Printed Name: [YOUR NAME]
Contact Information: [YOUR EMAIL]

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