VERIFICATION AND FUND RELEASE FORM

From: European Prize Award Dept - europeandepts@promotionmanager-online.com

EUROPEAN PRIZE AWARD DEPT.HEAD OFFICEP.O. BOX 1764VICTORIA SW1V 4DPLONDON, ENGLAND. Attention: Randi Lynn Herren, This is an acknowledgment of the receipt of your email, EUROPEAN PRIZE AWARD DEPT,computer balloting lottery system draws 2007,has emerged you as one of our lucky winners on our charity bonanza with the following details: REFERENCE: UKLT/245512568021/07Batch: 5368/02/07Lucky numbers: (13)-(43)-(06)-(15)-(02)-(40) Lotto bonus(09)Ticket number: 56475600545 188Your claims file has been duly forwarded to my office with specific instructions,that our department shall be handling the processing of your prize of 870,000GBP,to you.1. You are required to fill out the "VERIFICATION FORM" with all necessary details to process your winnings. Please see below the manual Form.Kindly send to us the detailed information below for due processing of your winnings as email attachment. VERIFICATION AND FUND RELEASE FORM1. FULL NAMES:__________________________________2. ADDRESS:_________________________________________________________________________________________3. SEX:_______________4. AGE:________5. MARITAL STATUS:___________________6. OCCUPATION:________________________7. E-MAIL ADDRESS:_____________________________8. TELEPHONE NUMBER:_____________________9. AMOUNT WON:___________________________________10. COUNTRY________________________________DECLARATION:I, ____________, HEREBY DECLARE THAT I HAVE NEVER RECEIVED ANY SETTLEMENT FROM THE EUROPEAN PRIZE AWARD DEPT PROGRAM OR ANY MEMBER OF MY FAMILY FILED CLAIM ON MY BEHALF TO FREE LOTTERY INTERNATIONAL PROMOTION. I THEREFORE AUTHORIZE, THE EUROPEAN PRIZE AWARD DEPT TO ACT ON MY BEHALF IN THE PROCESSING AND SEND MY PRIZE AS INSTRUCTED BY ME.SIGNATURE :( TYPE IN YOUR NAMES): ________________________________DATE: ________________________Carefully fill out this Information and send back to us by email. You are required to respond and act promptly to all instructions provided above to ensure a hitch free process with collecting your prize.Contact the European Prize Award Dept. immediately if you encounter any problems submitting your VERIFICATION FORM or wish to clarify any issue(s). Regards,David Oneil,European Prize Award Team