Hotel Name: Hotel Address: Date:

Guest Name: Room Number: Reservation Number (if applicable): Contact Information (phone/email):

Date & Time Lost Key Was Discovered Missing: Description of Incident: Actions Taken (searched room, notified staff, etc.):

I, the undersigned, declare that I have lost the room key(s) assigned to me. I understand that I may be responsible for any charges or fees related to the loss, as stated in the hotel’s policy.