Ultimate Bulk® Foundation

Email:

Desired Data Entry Name/Identification:

Customer Information

Name:

Mailing Address 1:

Address 1:

Mailing Address 2:

Address 2:

Date of Birth:

Year

Nationality:

Occupation:

Employer/Company Name:

Employer's

Address 1:

Employer's Address 2:

Have You Ever Directly/Indirectly Participated In Any Lottery programme (YES/NO),If yes,Please State

(YES/NO):

Telephone Number:

Fax Number:

Reference Number:

Batch Number:

Winning Number:

I, hereby endorse this form B-O7 and agree to abide by the rules and laws governing Lucky7 Lotto® Lottery.
TERMS AND CONDITIONS FOR COLLECTING WINNINGS.
1. Winners must be above 18 years old.

2. Winners must agree to abide by the terms of the Official Rules on winnings,which are final on all matters.

3. Acceptance of any prize constitutes permission for Lucky7 Lotto® Lottery and their advertising and promotional agencies to use winner's name and likenesses for advertising and promotional purposes without additional compensation unless prohibited by law.All prizes are subject to eligibility verification.In the event that the Grand Prize winner is deemed a minor in his/her state of residence,the prize will not be awarded.

4. LIMITATION OF LIABILITY :
Lucky7 Lotto® Lottery is not responsible for lost,incomplete, misdirected or late entries. Lucky7 Lotto® Lottery is not responsible for any incorrect or inaccurate information, whether caused by web site users, tampering, hacking, or by human error, which may occur in the processing of the application for claim.

Lucky7 Lotto® Lottery reserves the right at its sole discretion to cancel, terminate, winners prize money if it discovered that any of the information provided by winners in the application form for claim is discovered to be false.

5. DISPUTES
Winners agrees that any and all disputes which cannot be resolved between the parties, and causes of action arising out of or connected with the game, shall be resolved individually, without resort to any form of class action, exclusively, before a court located in the City of Johannesburg having competent jurisdiction, which Court shall apply the laws of the Johannesburg without regard for doctrines of Conflict of Law.

Further, in any such dispute, under no circumstances will participant be permitted to obtain awards for,and hereby waives all rights to claim punitive,incidental or consequential damages, or any other

Will You Like To Grant Press Conference?
(YES/NO):
Signature/Name:	Certified Date:	Year