Free Affidavit of Non-Receipt of Payment Outline Template
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:
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Payer Name: Pearl Bergna
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Amount Due: $5,000.00
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Payment Due Date: August 15, 2050
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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:
|
Date of Payment Request |
Amount Due |
Expected Payment Method |
Transaction Reference |
|---|---|---|---|
|
August 15, 2050 |
$5,000.00 |
Bank Transfer |
TRX-9856-JD |
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]
