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Claim Form

Claim Form

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Rafael Lopez
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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255 views

Claim Form

Claim Form

Uploaded by

Rafael Lopez
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

English || Espaol || Franais || Norsk || Portugus || Portugus do Brasil || || Suomi || Svenska

PlasmaNet Inc.
P.O. BOX 4562,
NEW YORK, NY 10163

Respond by: July 12th, 2016

CERTIFIED WINNER CLAIM FORM


201312

Samsung 65" 3D LED Smart TV


Dell Inspiron Laptop Computer

Use the form below to claim your prize. You are a


guaranteed winner of one of the prizes listed to the
left.

Apple iPad Mini

Authorized by:

$50.00 SkyAuction Savings Certificate

Section

Code No. PSN20121205

A: Grand Prize Value Disclosure

You have been directed to this prize claim form because you are a verified and confirmed
winner of one of the prizes listed above. The Grand Prize value is:

$3,500.00
Section

B: Claim Information

Note: You are a guaranteed winner of one of the prizes listed above. Fill out the form below
to claim your prize.

Failure to complete this form in its entirety may result in forfeiture of your prize.
First Name

Last Name

Address1

Address2

City

Postal Code

Region

Country

Philippines

Your prize notification and FreeLotto entry confirmations, daily results and sponsored advertising
messages will be sent by e-mail only from FreeLotto:
Email

Confirm Email

This confirmation is contingent upon meeting the age and residency requirement. These prizes are
being offered by FreeLotto.com as part of a worldwide publicity campaign. Offer is valid for a limited
time.

CLAIM NOW

By clicking on CLAIM NOW above, I acknowledge that I have read the Official Rules, Sweepstakes
Rules and FreeLotto Privacy Policy and agree to be bound by them.

Why are we giving away these AMAZING PRIZES?


As part of a worldwide publicity campaign, we're giving away a FREE award valued up to $3,500.00. This is NOT a
joke! By entering this sweepstakes you will also have joined FreeLotto.com. With daily opportunities to win over
$11,000,000.00, FreeLotto is the ultimate destination for winning free money online! Since 1999, FreeLotto has
awarded OVER $104,000,000.00, created 26 millionaires, and YOU COULD BE NEXT. This is a limited time
offer so act fast and act now.
After you've processed your claim you'll be notified of exactly what your prize is and we will arrange delivery to you.
This is totally free, we even pay the shipping. But you've got to act fast.
Best of all, after you process your claim you will have joined FreeLotto - where you'll get a free chance at winning
over $11 million in daily prizes. We've already awarded over $104 million in prizes, and you can become our next
millionaire!
This promotion is sponsored by FreeLotto and is not associated with any of the above listed brands. The above
listed trademarks are the property of their respective owners. This promotion is in no way affiliated with Samsung,
Dell, Apple, or Sky Auction. No purchase is necessary to enter.
Copyright 1999-2016 PlasmaNet, Inc. All rights reserved. Reproduction in whole or in part in any form or medium without
the express written permission of PlasmaNet, Inc. is prohibited. PlasmaNet, Inc., www.freelotto.com, their agencies and
advertisers are not responsible for any incorrect or inaccurate information or formatting, whether caused by internet users or
by any of the equipment, programming or software associated with or utilized in connection with the Sweepstakes. Void
where prohibited. PlasmaNet, Inc. is not responsible for any errors or omissions.
PlasmaNet Inc. PO Box 4562, Grand Central Station, New York, NY 10163, USA.

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