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Claim Form

1. The document is a claim form for prize winners of the Punjab state lottery. It requests information such as the winner's name, address, contact details, bank account information, prize amount, and ticket number. 2. The form instructs winners to attach photographs, a cancelled cheque, and affidavits if applicable. It notes prizes must be claimed within 30 days of the gazette notification or reasons for delay provided via affidavit. 3. Once completed, the form allows the lottery organizers to verify the winner and transfer the prize amount to their nominated bank account.

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14K views2 pages

Claim Form

1. The document is a claim form for prize winners of the Punjab state lottery. It requests information such as the winner's name, address, contact details, bank account information, prize amount, and ticket number. 2. The form instructs winners to attach photographs, a cancelled cheque, and affidavits if applicable. It notes prizes must be claimed within 30 days of the gazette notification or reasons for delay provided via affidavit. 3. Once completed, the form allows the lottery organizers to verify the winner and transfer the prize amount to their nominated bank account.

Uploaded by

Anonymous OnbGeXbwm
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

GOVERNMENT OF PUNJAB

DIRECTORATE OF PUNJAB STATE LOTTERIES


S.C.O. No. 106- 108, SECTOR -17-D, CHANDIGARH
Claim form for the prize winner (s) of Punjab state
__________________
Held on___________________
1.
Name of the winner (S) ___________________________________
(In Block Letters)
2.
Minor or Major
___________________________________
3.
Fathers/ Husband Name
___________________________________
4.
Permanent Address
____________________________________
(In Block Letters)
5.
Present Address
___________________________________
6.
Telephone/ Mobile Number ___________________________________
7.
Occupation
___________________________________
8.
Pan Number
___________________________________
9.
Prize winning Ticket/
Coupon Number
___________________________________
10. Date of Draw
___________________________________
11. Amount of Prize
___________________________________
12. Detail of Account to which
the prize Amt to be transferred.
a) Nature of Account _________________________
b) Account No
_________________________
c) Name of Bank
_________________________
d) Address of Bank
________________________
e) IFSC Code of bank _________________________
(Please enclose a cancelled cheque )
Date
Claimant

Signature of

Advance Receipt
Received a sum of Rs. _______________ Rs.___________________________
from Director Punjab State Lotteries, Chandigarh being the prize
amount
against
Ticket
No.
__________
of
Punjab
State_________________________Draw held on ___________________
Signature of the
Claimant
(With Revenue Stamp)
Instructions
1.
Affix three passport size Photographs with Claim Form out of
which two should be duly attested by 1st Class Magistrate/
Notary Public/ Oath Commissioner any Gazetted Officers.
2.
Please enclose a cancelled cheque of account where the
winning amount is to be transferred.
3
In case of Claimant is Minor than an Affidavit from the National
Guardian/ Parent should be attached with the Claim Form.

4.

In case Prize is not claimed within the prescribed period (30


days from the date of Gazette Notification) then reasons of this
on an Affidavit should be attached with the claim Form.

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