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Wednesday, July 18, 2007

VERIFICATION AND CLEARANCE FORM

From: CLAIMS AGENT - internationalclaimsagent_bledsoe@yahoo.co.uk

ATTENTION: Winner,

Congratulations once again from all the staff here. In order to verify your winnings, we need your particulars for record purposes. Attached here is a copy of our verifications form, please fill accordingly so as to proceed with your winnings. Once again congratulations from all the staff.

Upon receipt of the duly requested data, I will send you the contact information of the payments office so you can proceed with effecting the release of your claim in any way you deem fit.

VERIFICATION AND CLEARANCE FORM


1. FULL NAMES:

COMPANY NAME (IF APPLICABLE):

2.ADDRESS:

3.SEX:

4.AGE:

5.MARITAL STATUS :

6.OCCUPATION

7.E-MAIL ADDRESS:
8.TELEPHONE NUMBER(S): FAX:
9.DATE OF BIRTH:
10. BATCH NUMBER B. REF NUMBER:

11.BRIEF DESCRIPTION OF COMPANY/INDIVIDUAL:


12. AMOUNT WON:

13. COUNTRY:

14. PRIZE WINNING DETAILS (TICKET NO.): Serial NO.:


NOTE: THIS VERIFICATION FORM SHOULD BE COMPLETELY FILLED OUT AND E- MAILED BACK TO ME WITHIN 72HOURS OF RECEIPT OF THIS FORM.

Warm Regards,


Mr Terry Bledsoe
Tel: +447045703203.

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