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Claim Form
Those who feel difficulty to claim the prize
Ticket Details
Ticket Name:
Opal
Topaz
Silver
Gold
Platinum
Diamond
Ticket Number:
Purchased Date:
Result Date:
Amount own of the customer:
Personal Details
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Country:
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Date Of Birth:
Gender:
Male
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Marital Status:
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Address:
Bank Details(Optional)
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IFSC:
PAN number if any:
