Mr .Williams Smith.
(Fiduciary Agent)
TEL: +27-73-597-8611
You are advised to fill in the bellow form and submit to your fiduciary Agent in South Africa,to avoid unnecessary delays and complications:
(1) FULL NAME:...........................................................
(2) MARITAL STATUS:.................................................
(3) RESIDENT ADDRESS:.............................................
(4) COUNTRY OF ORIGIN:.............................................
(5) OCCUPATION:........................................................
(6) DATE OF BIRTH:....................................................
(7) MALE/ FEMALE:....................................................
(8) COMPANY'S NAME:................................................
(9) PHONE AND FAX NUMBER:.....................................
(10) TICKET NUMBER:.................................................
(11) SERIAL NUMBER:................................................
(12) WINNING NUMBER:..............................................
# Please you are to choose your payment option at which you want your winning fund paid to you; Listed bellow is our payment modalities and option of payment.
(1) TRAVELLING TO SOUTH AFRICA FOR CASH COLLECTION (Send Flight Schedule to confirm your date of arrival in South Africa):..............
(2) TELEGRAPHIC WIRE TRANSFER:................................
(3) THROUGH DIPLOMATICE MEANS...............................
Thank you for being part of this POWERBALL LOTTO program.Our special thanks and gratitude to Bill Gates and his associates.We wish you the best of luck as you spend your good fortune.This promotion takes place monthly. PLEASE NOTE! Any claim not made before Fifteen (15) working days from date of notification will indicate that the winner has voluntarily forfeited his/her winnings. For security reasons you advice to keep your winning information confidential till claims is processed and your money remitted to you in whatever manner you deem fit to claim you prize.
Sincerely Yours
Mrs.Caroline Owen
Multi-State Lottery Association
(Coordinator)