One97 Communicat ions Limit ed

B-121, Sect or- 5, Noi da- 201301

PRIZE REDEMPTION FORM FOR "PowerPl ay Qui z" CONTEST

(Pl ease read inst ruct ions overleaf)

PLEASE FILL IN WITH CAPITAL LETTERS

________________________ ________________________ ____________________________

1. FIRST NAME 2. MIDDLE NAME 3. SURNAME

4. DATE OF BIRTH (dd-mm-yyyy): ________________ (At t ach Copy of age Proof)*

5. GENDER (M/ F): _______

6. RESIDENCE ADDRESS: ______________________________________________________________

______________________________________________________________

CITY ____________ STATE ________________ PIN CODE ______________

7. PAN No.: _______________ Post paid Mob.No. : ________________ Prepaid Mob. No.: ______________
(Pl s. At t ach Copy)* (Pl s. At t ach Copy of Bi l l )*

8. E-MAIL ADDRESS: ________________

9. Winner of WEEKLY/ MONTHLY/ Bumper PRIZE: _________________________________

10. ATTACH PROOF OF IDENTITY: ______________

(PASSPORT COPY/ RATION CARD / VOTERSID CARD / PAN CARD / DRIVING LICENCE)

I hereby sol emnl y declare t hat I have read & underst ood t he inst ruct ions post ed on websit e
(ht tp:/ / one97.com/ cont est / Megawin/ ) and agree t o al l t he t erms & condit ions st at ed t herein. I hereby
furt her st at e t hat
(a) I am over t he age of 18 years;
(b) I was an act ive and exist ing subscriber at t he t ime of compet it ion;
(c) I have been neit her prosecut ed nor convict ed for commit t ing any criminal off ence or abet ment
t hereof;
(d) I am not suffering from any l egal disabil it y e.g. insol vency, rest raint by court et c;
(e) I do not have any out st anding dues payabl e t o operat or on account of t he mobil e connect ion

and t he informat ion supplied above are t rue and correct t o my knowl edge. I undert ake t o be l iabl e for
any fal sit y in informat ion provided or misrepresent at ions made herein and agree t o bind myself t o any
penal t y t hat One97 Communicat ions Limit ed ("Company"), in it s sol e discret ion may impose, incl uding
forfeit ing t he prize redempt ion and submit t o t he l iabil it y under Indian l aws. I agree t hat by signing
t his form and redeeming t he prize, my name, l ocal it y, ot her personal informat ion and t he prize
amount woul d become publ ic informat ion.

Dat e: (dd-mm-yyyy) ________________ Redeemers Signat ure: __________________

*Applicabl e for Weekly/ Mont hly/ Bumper prize winner.