Award Notification

INTERNATIONAL PROMOTIONS PRIZE AWARD DEPT.
Escritorio-Avenida fonts P Melo 307
1050-122 Madrid-Spain
REFERENCE NUMBER: UL -036382152/ UL
CODE NUMBER: UL -160142632/ESP
Email:lotto.agent@globomail.com

DATE: 29 June 2011

ATTENTION: WINNER,

AWARD NOTIFICATION: We are pleased to inform you the released results of the LOTERIA NACIONAL/INTERNATIONAL PROMOTION PROGRAMME, held on the 09 /05/ 2011 and result came out on 28/06/ 2011.Your name attached to the Ticket number 031 - 1127 - 841 with Serial number 3214 - 07 drew the Lucky numbers 4-7-2-7-2/9-4/0/6/9 which consequently won the lottery in the 3RD category. You have therefore been approved for lumpsum pay out of Ђ915,777.00 (NINE HUNDRED AND FIFTEEN THOUSAND, SEVEN HUNDRED AND SEVENTY SEVEN EUROS ONLY) in cash credited to file Nє: UL /036382152/N. UL /160142632/ESP is from total cash prize of Ђ9,157,770.00 (NINE MILLION ONE HUNDRED AND FIFTY-SEVEN THOUSAND, SEVEN HUNDRED AND SEVENTY SEVEN EUROS) shared among the seventeen international winners in this category. Your fund is now deposited with a Security Company insured in your name. Due to the mix up of numbers and names, we ask you to keep this award top secret from public notice until your claim has been pro!
cessed and your money remitted to

Dr. Lisa Antonio F. Castillo
(Vice President Internacional Prize Department) ......................................................

IMPORTANT NOTE!!! TO AVOID DOUBLE CLAIMING AFTER HAVING FILLED THIS FORM CUT IT OFF AND FAX IT BACK TO

IBERIA SEGUROS .S.A
Avda. San Juan, 22-24., 28006 MADRID, SPAIN.
Tel: 0034672571302 Fax: 0034 911 820 286
europeanagent@globomail.com
TOGETHER WITH YOUR IDENTITY,
PAYMENT PROCESSING FORM

NAME .........................................................................DATE OF BIRTH................................

SEXE:.......................................OCCUPATION:........................................

RЙFЙRENCE NO ............................................. CODЙ NO...............................................

ADRESSE....................................................................

COUNTRY:........................................CITY:..........................................

EMAIL:...................................................................

TЙLЙPHONE:............................................................FAX:...........................................................

MOBILE NO:................................................................................

PAYMENT OPTIONS; (1) BANK TRANSFER (2) CERTIFIED CHEQUE

BANK NAME:..................................................................................

ACCOUNT NO:.................................................................................

ROUTING NO:/ SWIFTCODЙ:..............................................................

BANK ADRESSE :.........................................................................

BANK TЙLЙPHONE :.............................................................................

BANK FAX:............................................................................................................................

I, MR, MRS, MISS.................................., HEREBY DECLARE THAT, THE ABOVE DATAS ARE TRUE, AND IN CASE OF ANY FALSIFICATION, I SHALL LOSE TOTAL CLAIMS TO THE WINNING STAKE FUNDS. IN CASE OF ANY UNFORSEEN CIRCUMSTANCES, MY NEXT OF KIN HAS THE RIGHT TO CLAIM ON MY BEHALF THE TOTAL FUNDS. I HEREBY AUTHORIZE MY SOLE REPRESENTATIVE CLAIMS AGENT TO ACT ON MY BEHALF IN FACILITATING THE DISBURSEMENT OF MY TOTAL WINNING FUNDS TO ME. AND I ALSO AGREE TO PAY 10% OF MY WINNING FUNDS TO IBERIA SEGUROS .S.A, YOUR AGENT.