Sample Returns Report (prize discharge form)

COMPANY LETTER HEAD

NAME OF PROMOTION/LOTTERY

I__________________________ID.No._______________MobileNo.__________________

hereby confirm that I participated in the above promotion.

I participated in the _____________________ prize competition / lottery as per the

terms and conditions and was duly selected as a winner

_____________________________prize through raffle draw selection supervised by

Betting Control & Licensing Board (BCLB).

I hereby confirm that I have received and collected the said prize.

Winners Name: ____________________________ Date: _________________________

Signature: ___________________

Witnessed by:

Organizations Representative Name: ______________________________

Date: ___________________________Signature: ___________________

Proof of identity must be attached.