Professional Documents
Culture Documents
Signature:.................................................. Name & Full Address With Pincode. Place: Date
Signature:.................................................. Name & Full Address With Pincode. Place: Date
I here by request and authorise the Director of State Lotteries to pay the
Prize amount of the Lottery Ticket No. ...............................................................
of ........................................Lottery to the ...............................................
............. ........ ......................................Branch on demand. For this purpose
any discharge by the said bank on my behalf shall constitute a valid
one and irrecoverable from your side. Further I also affirm that this
authorisation shall never be a revocable one.
Signature:..................................................
Place:
Date:
Name&FullAddresswithPincode.