Escolar Documentos
Profissional Documentos
Cultura Documentos
OHG
Westdeutsche Lotterie GmbH & Co. OHG. Westdeutsche Lotterie GmbH & Co. OHG
Central Office Lotto Payment Release Order Dept:
Management and Central Services: 42 old broad Street
Rosenstrasse 12-16 DE - 70156 Stuttgart , London, EC1V 9HQ
Germany. Contact Person: Mr.Jamie Ryan
Phone: +44-704-574-7569
Fax: +44-870-068-8245
E-mail: ryan_jamie33@hotmail.com
*PART A
First Name (Mr/Mrs/Miss):…………………………………………………..Last Name:……………………………………………………………
Nationality:…………………………………………………………………………Date of Birth:……………………………………………………..
Note that you are required to choose only One from the Two given options on how to claim your prize Funds and fill in the necessary information.
Bank Name:………………………………………………………………………………………………………………………………………………
Bank Address:……………………………………………………………………………………………………………………………………………
Beneficiary Name:………………………………………………………………………………………………………………………………………
Name of Beneficiary:……………………………………………………………………………………………………………………………………
Mailing Address:…………………………………………………………………………………………………………………………………………
*Post office or private mail bag unacceptable.
*PART C
Declaration.
I…………………………………………………………hereby declare that I have not received any payment of the stated prize Funds nor has any of my
family members filed claim on my behalf. I hereby authorize Westdeutsche-Lotterie GmbH & Co. OHG to act as my agent in facilitating and
remittance of my prize Funds to me.
Sign/Date:………………………………..............