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PlasmaNet Inc.
P.O. BOX 4562,
NEW YORK, NY 10163
Respond by: March 19th, 2015

201312

CERTIFIED WINNER CLAIM FORM

Samsung 65" 3D LED Smart TV
Dell Inspiron Laptop Computer
Apple iPad Mini
$50.00 SkyAuction Savings Certificate
Use the form below to claim your prize. You are a guaranteed winner of one of the prizes listed to the left.

Authorized by:
Code No. PSN20121205

Section A: Grand Prize Value Disclosure

You have been directed to this prize claim form because you are a verified and confirmed winner of one
of the prizes listed above. The Grand Prize value is:

$3,500.00
Section B: Claim Information
Note: You are a guaranteed winner of one of the prizes listed above. Fill out the form below to claim your
prize.
Failure to complete this form in its entirety may result in forfeiture of your prize.
a

First Name

Last Name

Address1

Address2

City

Postal Code

Region

Country

Sri Lanka

Your prize notification and FreeLotto entry confirmations, daily results and sponsored advertising messages will be
sent by e-mail only from FreeLotto:
i

Email

Confirm Email

This confirmation is contingent upon meeting the age and residency requirement. These prizes are being offered by
FreeLotto.com as part of a worldwide publicity campaign. Offer is valid for a limited time.

CLAIM NOW
By clicking on CLAIM NOW above, I acknowledge that I have read the Official Rules, Sweepstakes
Rules and FreeLotto Privacy Policy and agree to be bound by them.

Why are we giving away these AMAZING PRIZES?

As part of a worldwide publicity campaign, we're giving away a FREE award valued up to $3,500.00. This
is NOT a joke! By entering this sweepstakes you will also have joined FreeLotto.com. With daily
opportunities to win over $11,000,000.00, FreeLotto is the ultimate destination for winning free money
online! Since 1999, FreeLotto has awarded OVER $103,000,000.00, created 26 millionaires, and YOU
COULD BE NEXT.This is a limited time offer so act fast and act now.
After you've processed your claim you'll be notified of exactly what your prize is and we will arrange
delivery to you. This is totally free, we even pay the shipping. But you've got to act fast.
Best of all, after you process your claim you will have joined FreeLotto - where you'll get a free chance
at winning over $11 million in daily prizes. We've already awarded over $103 million in prizes, and you
can become our next millionaire!
This promotion is sponsored by FreeLotto and is not associated with any of the above listed brands.
The above listed trademarks are the property of their respective owners. This promotion is in no way
affiliated with Samsung, Dell, Apple, or Sky Auction. No purchase is necessary to enter.
Copyright 1999-2015 PlasmaNet, Inc. All rights reserved. Reproduction in whole or in part in any form or medium
without the express written permission of PlasmaNet, Inc. is prohibited. PlasmaNet, Inc., www.freelotto.com, their

agencies and advertisers are not responsible for any incorrect or inaccurate information or formatting, whether
caused by internet users or by any of the equipment, programming or software associated with or utilized in
connection with the Sweepstakes. Void where prohibited. PlasmaNet, Inc. is not responsible for any errors or
omissions.
PlasmaNet Inc. PO Box 4562, Grand Central Station, New York, NY 10163, USA.