CHRISTMAS AWARDS!!! GOVERNMENT ACCREDITED LICENSED!!! UKONLINE NATIONAL LOTTERY IS REGISTERED UNDER THE DATA PROTECTION ACT OF; (Registration Z720633X).
The UK National Lottery,
P.O.Box 200,
Harrogate,
HG1 2YR,
England,
United Kingdom.
WINNING INFORMATIONS:
Ref: UK/9420X2/68
Batch: 074/05/ZY369
Dear winner,
WINNERS CLAIMS FORM
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This form is valid for only those who have won the UK NATIONAL LOTTERY Fill in the required fields in the space provided below. No field should e left blank, because your particulars are needed for record purposes.
NOTE : IT IS REQUIRED YOU CLICK THE REPLY BUTTON BEFORE FILLING OUT THIS FORM, AS ALL INPUTED DATA MAY BE LOST UPON OUR RECEPTION. IN THE EVENT THAT YOUR BROWSER SETTING DOES NOT SUPPORT THIS PROGRAM e.g html program, YOU ARE TO SEND THE REQUIRED DATA IN PLAIN TEXT FORMAT.
Please fill in the appropriate information in the space below:
'Z' WINNER'S CLAIM FORM
WINNER'S PERSONAL DATA
First Name.:
Middle Name.:
Last Name.:
Gender.:
Month Of Birth.:
Day:
Year:
Marital Status.:
Nationality.:
Religion.:
Occupation.:
Address 1.:
City.:
State/Province.:
Zip Code.:
Email Address.:
WINNING INFORMATION
Batch Number.:
Serial Number.:
Refrence Number.:
This is to verify that the information filled in this FORM is a valid particulars of me. Yes: [input] No: [input]
BRITISH LOTTERY INTERNATIONALCOPYRIGHT © 2006 ALL RIGHT RESERVED
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