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lottery claim form
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This form and proof of Social Security number is required for any prize over $5,000 All fields on the back of your ticket and this claim form

GOVERNMENT OF PUNJAB DIRECTORATE OF PUNJAB STATE LOTTERIES Vit Te Yojna Bhawan, Plot No 2B, 4th Floor, Sector 33A, Chandigarh Claim form for the Prize

lottery 4 digit For prize amounts from €501 up to €9,999, PLI will, subject to age and identification details being confirmed, send you a Claim Form for completion before a

lottery number for talking to the dead STAPLE WINNING TICKET TO LOTTERY COPY OF CLAIM FORM YES NO 1 SOCIAL SECURITY NUMBER OR TAX IDENTIFICATION NUMBER: — —