Claim Forms

50/50 PRIZE CLAIM FORM

 

Date : _________________________

 

Name of 50/50 Winner : ______________________

Address: ____________________________________

City/Province: ______________________________

Postal Code : _______________________________

Phone : _____________________________________

Email : _____________________________________

 

I ACKNOWLEDGE I AM A RESIDENT OF OTARIO, CANADA AND I AM OVER THE AGE OF 18, AS EVIDENCE BY MY SUPPORTING DOCUMENTATION.

Signature: ____________________________________

 

Easter Seals Ontario USE ONLY

 

ACKNOWLEDGEMENT THAT ID WAS SEEN BY AND EASTER SEALS ONTARIO LOTTERY OFFICIAL. AS PROVEN BY THE FOLLOWING DOCUMENTATION:

               

Last 3 digits of valid ON – Identification Card: __________

Signature: _______________