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To: oliver_smith13@ig.com.br From: WINNING NOTIFICATION <oliver_smith13@ig.com.br> Date: Wed, 21 Mar 2007 16:46:49 -0300 Message-ID: <20070321_194649_026829.oliver_smith13@ig.com.br> MIME-Version: 1.0 Content-type: multipart/mixed; boundary="Message-Boundary-by-Mail-Sender-1174506409" This message is in MIME format. Since your mail reader does not understand this format, some or all of this message may not be legible. --Message-Boundary-by-Mail-Sender-1174506409 Content-type: text/html; charset=ISO-8859-1 Content-description: Mail message body Content-transfer-encoding: 8bit Content-disposition: inline <BODY bgcolor='#ffffff' style='background-color:#ffffff; width:605px;'> <DIV id=yiv262860277> <DIV><STRONG><FONT face=system><FONT color=#000000><FONT color=#0033ff><FONT color=#333399><FONT color=#333399><FONT size=2><IMG style="WIDTH: 468px; HEIGHT: 90px" height=56 src="http://bestanimations.com/Text/Welcome/Welcome-03-june.gif" width=140 border=0></FONT> </FONT></FONT></FONT></FONT><FONT color=#000000><FONT color=#0033ff><FONT color=#333399><FONT color=#333399> <FONT color=#660000> </FONT></FONT></FONT></FONT></FONT></FONT></STRONG></DIV> <DIV><FONT color=#000000><FONT color=#0033ff><FONT color=#333399><FONT face=system color=#333399><STRONG></STRONG></FONT></FONT></FONT></FONT> </DIV> <DIV><FONT color=#000000><FONT color=#0033ff><FONT color=#333399><FONT color=#333399><FONT color=#660000></FONT></FONT></FONT></FONT></FONT> <DIV><SPAN style="FONT-SIZE: 9pt; COLOR: black"><FONT color=#000000><FONT color=#0033ff><FONT color=#333399><FONT color=#333399><FONT color=#660000><SPAN style="FONT-SIZE: 9pt; COLOR: black"><FONT color=#330099><SPAN style="FONT-SIZE: 9pt; COLOR: black"><FONT color=#330099><A href="http://mail.yahoo.com/config/login?/_java-script:ol%28%27http://mail.yahoo.com/config/login?/__java-script:olhttp://www.uknationallottery.com/changelanguage.php?ID%253d1%2526amp;URL%253drules.php;%27%29;" target=_blank rel=nofollow><FONT face=system color=#330099 size=2><STRONG><IMG style="WIDTH: 143px; HEIGHT: 73px" height=62 src="http://www.uknationallottery.com/flags/1.gif" width=237 border=0></STRONG></FONT></A><FONT face=system size=2><STRONG> </STRONG></FONT><A href="http://www.national-lottery.co.uk/player/p/home/home.do" target=_blank rel=nofollow><EM></EM></A><FONT face=system color=#0000ff size=2><EM><STRONG> </STRONG></EM></FONT></FONT></SPAN></FONT></SPAN><FONT face=system size=2><STRONG> <IMG style="WIDTH: 81px; HEIGHT: 78px" height=100 src="http://maxpages.com/images/animations/earth/earth.gif" width=100 border=0> </STRONG></FONT></FONT></FONT></FONT></FONT></FONT></SPAN></DIV> <DIV><FONT color=#000000><FONT color=#0033ff><FONT color=#333399><FONT color=#333399><FONT color=#660000><SPAN style="FONT-SIZE: 9pt; COLOR: black"><FONT face=system color=#330099 size=2><SPAN style="FONT-SIZE: 9pt; COLOR: black"><SPAN style="FONT-SIZE: 9pt; COLOR: black"><STRONG> </STRONG></SPAN></SPAN></FONT></SPAN></FONT></FONT></FONT></FONT></FONT></DIV> <DIV><FONT color=#000000><FONT color=#0033ff><FONT color=#333399><FONT color=#333399><FONT color=#660000><SPAN style="FONT-SIZE: 9pt; COLOR: black"><FONT face=system color=#330099 size=2><SPAN style="FONT-SIZE: 9pt; COLOR: black"><SPAN style="FONT-SIZE: 9pt; COLOR: black"><STRONG> </STRONG></SPAN></SPAN></FONT></SPAN></FONT></FONT></FONT></FONT></FONT></DIV></DIV> <DIV><FONT face=system color=#00007f><STRONG></STRONG></FONT> </DIV> <DIV><FONT color=#00007f> <DIV><FONT face=system><STRONG>UK National Lottery Headquarters.</STRONG></FONT></DIV></FONT></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 12pt; LINE-HEIGHT: 14.4pt"><SPAN style="FONT-SIZE: 10pt; COLOR: #00007f; FONT-FAMILY: Arial"><BR></SPAN><STRONG><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial"><FONT face=system>Reference Number: 074/05/ZY369</FONT></SPAN></STRONG><B><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial"><BR><FONT face=system><STRONG>Batch Number: UK/9420X2/68</STRONG><BR><STRONG>Grand Draw No: 12099</STRONG><BR><STRONG>Identification Number: KTU/<SPAN id=lw_1163740404_0 style="BORDER-BOTTOM: #0066cc 1px dashed"><FONT color=#000000><SPAN id=lw_1172424200_0 style="BORDER-BOTTOM: #0066cc 1px dashed"><SPAN id=lw_1172780664_0>9023118308</SPAN></SPAN></FONT></SPAN>/03</STRONG></FONT></SPAN></B><SPAN style="FONT-SIZE: 10pt; COLOR: #00007f; FONT-FAMILY: Arial"></SPAN></DIV><SPAN style="FONT-SIZE: 10pt; COLOR: #00007f; FONT-FAMILY: Arial"> <DIV class=MsoNormal style="MARGIN: 0in 0in 12pt; LINE-HEIGHT: 14.4pt"><BR></SPAN><STRONG><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial"><FONT face=system><FONT size=3> <U>WINNING NOTIFICATION</U></FONT></FONT></SPAN></STRONG></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 12pt; LINE-HEIGHT: 14.4pt"><FONT face=system><FONT size=2><STRONG><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial">The Management of UK NATIONAL LOTTERY Inc., United Kingdom is pleased to inform you of the results of the E-mail address ballot lottery international program held on 21st March 2007</SPAN></STRONG></FONT></FONT></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 12pt; LINE-HEIGHT: 14.4pt"><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"><FONT face=system size=2></FONT></SPAN></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 12pt; LINE-HEIGHT: 14.4pt"><FONT face=system><FONT size=2><STRONG><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial">Your e-mail address attached to ticket number: 56475600545188 with Serial number 5368/02 drew the lucky numbers: <IMG alt="Ball number 11" src="http://www.national-lottery.co.uk/player/i/small_balls_lotto/lotto_balls_small_11_redbg.gif"> <IMG alt="Ball number 13" src="http://www.national-lottery.co.uk/player/i/small_balls_lotto/lotto_balls_small_13_redbg.gif"> <IMG alt="Ball number 26" src="http://www.national-lottery.co.uk/player/i/small_balls_lotto/lotto_balls_small_26_redbg.gif"> <IMG alt="Ball number 34" src="http://www.national-lottery.co.uk/player/i/small_balls_lotto/lotto_balls_small_34_redbg.gif"> <IMG alt="Ball number 44" src="http://www.national-lottery.co.uk/player/i/small_balls_lotto/lotto_balls_small_44_redbg.gif"> <IMG alt="Ball number 48" src="http://www.national-lottery.co.uk/player/i/small_balls_lotto/lotto_balls_small_48_redbg.gif"> and bonus ball number: <IMG alt="Bonus Ball number 2" src="http://www.national-lottery.co.uk/player/i/small_balls_lotto/lotto_bonus_small_2_redbg.gif"> which </SPAN></STRONG><B><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial"><STRONG>subsequently won you the lottery in the 2nd category. You have therefore been approved to claim a total sum of Two hundred and Fifty Thousand US Dollars ($250,000) in cash credited to file KTU/<SPAN id=lw_1163740404_1 style="BORDER-BOTTOM: #0066cc 1px dashed"><FONT color=#000000><SPAN id=lw_1172424200_1 style="BORDER-BOTTOM: #0066cc 1px dashed"><SPAN id=lw_1172780664_1>9023118308</SPAN></SPAN></FONT></SPAN>/03. </STRONG></SPAN></B></FONT></FONT></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 12pt; LINE-HEIGHT: 14.4pt"><FONT face=system><FONT size=2><B><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial"><STRONG>Your winning is yet to be claimed and you are receiving the FINAL NOTIFICATION with effect to this email notice. </STRONG></SPAN></B><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"></SPAN></FONT></FONT></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 12pt; LINE-HEIGHT: 14.4pt"><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"><FONT face=system size=2></FONT></SPAN></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 12pt; LINE-HEIGHT: 14.4pt"><FONT face=system><STRONG><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial"><FONT size=2>All participants of this online version were selected randomly from World Wide Web sites through computer draw system and extracted from over 1,000,000 unions, associations, and corporate bodies that are listed online. This promotion takes place annually.</FONT> </SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"></SPAN></FONT></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 12pt; LINE-HEIGHT: 14.4pt"><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"><FONT face=system></FONT></SPAN></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 12pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial"><FONT face=system>This is from a total cash prize of $2,500,000 (Two Million Five Hundred Thousand Dollars) shared amongst the first Ten (10) lucky winners in this category. </FONT></SPAN></STRONG><B><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial"><BR><FONT face=system><STRONG> </STRONG><BR><STRONG>Your lucky winning category #2 (two) falls within our West African booklet representative office in Africa from the five (5) booklet representatives viz. <SPAN id=lw_1163740404_2 style="BORDER-BOTTOM: #0066cc 1px dashed"><FONT color=#000000><SPAN id=lw_1172424200_2 style="BORDER-BOTTOM: #0066cc 1px dashed"><SPAN id=lw_1172780664_2>London</SPAN></SPAN></FONT></SPAN>, Sydney, <SPAN id=lw_1163740404_3 style="BORDER-BOTTOM: #0066cc 1px dashed"><FONT color=#000000><SPAN id=lw_1172424200_3 style="BORDER-BOTTOM: #0066cc 1px dashed"><SPAN id=lw_1172780664_3>Seoul</SPAN></SPAN></FONT></SPAN>, <SPAN id=lw_1163740404_4 style="BORDER-BOTTOM: #0066cc 1px dashed"><FONT color=#000000><SPAN id=lw_1172424200_4 style="BORDER-BOTTOM: #0066cc 1px dashed">Lagos</SPAN></FONT></SPAN> & <SPAN id=lw_1163740404_5 style="BORDER-BOTTOM: #0066cc 1px dashed"><FONT color=#000000>Atlanta</FONT></SPAN> as indicated in your play coupon. </STRONG></FONT></SPAN></B><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"></SPAN></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 12pt; LINE-HEIGHT: 14.4pt"><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"><FONT face=system></FONT></SPAN></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 12pt; LINE-HEIGHT: 14.4pt"><FONT face=system><FONT size=2><STRONG><SPAN style="COLOR: black; FONT-FAMILY: Arial">In view of this, your $250,000 (Two Hundred and Fifty Thousand US Dollars only) would be released to you by any of our payment officer in any of these countries.</SPAN></STRONG></FONT></FONT><FONT face=system><STRONG><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial"> </SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"></SPAN></FONT></DIV> <DIV><STRONG><FONT face=system color=#00007f> </FONT></STRONG></DIV> <DIV class=RTE><FONT color=#00007f> <TABLE cellSpacing=0 cellPadding=0 width=450 border=0> <TBODY> <TR> <TD width=10><BR><STRONG><FONT face=system color=#00007f size=2></FONT></STRONG></TD> <TD> <TABLE cellSpacing=0 cellPadding=0 width=40 border=0> <TBODY> <TR> <TH bgColor=#f6c602><FONT face=system color=#00007f size=2><IMG height=21 hspace=0 src="http://images.freelotto.com/www.freelotto.com///images/en/default/CornerTopLeftYellow.gif" width=21 align=left border=0></FONT></TH> <TH bgColor=#f6c602><FONT face=system size=2> </FONT></TH> <TH bgColor=#f6c602><FONT face=system size=2><IMG height=21 hspace=0 src="http://images.freelotto.com/www.freelotto.com///images/en/default/CornerTopRightYellow.gif" width=21 align=right border=0></FONT></TH></TR> <TR> <TH bgColor=#f6c602><FONT face=system size=2> </FONT></TH> <TH vAlign=center bgColor=#f6c602><FONT face=system size=2>YOUR TICKET NUMBER</FONT></TH> <TH bgColor=#f6c602><FONT face=system size=2><IMG src="http://images.freelotto.com/www.freelotto.com///images/en/default/click2win-arrow.gif"></FONT></TH></TR> <TR> <TH vAlign=bottom bgColor=#f6c602><FONT face=system size=2><IMG height=21 hspace=0 src="http://images.freelotto.com/www.freelotto.com///images/en/default/CornerBottomLeftYellow.gif" width=21 align=left border=0></FONT></TH> <TH bgColor=#f6c602><FONT face=system size=2> </FONT></TH> <TH vAlign=bottom bgColor=#f6c602><FONT face=system size=2><IMG height=21 hspace=0 src="http://images.freelotto.com/www.freelotto.com///images/en/default/CornerBottomRightYellow.gif" width=21 align=right border=0></FONT></TH></TR></TBODY></TABLE> <DIV><STRONG><FONT face=system size=2></FONT></STRONG></DIV> <DIV><STRONG><FONT face=system size=2></FONT></STRONG> </DIV> <DIV><STRONG><FONT face=system size=2></FONT></STRONG> </DIV></TD> <TD align=left> <TABLE cellSpacing=0 cellPadding=0 width=340 border=0> <TBODY> <TR> <TD> <DIV><STRONG><FONT face=system size=2></FONT></STRONG> </DIV> <DIV><INPUT type=submit value="56475600545 188 "><STRONG><FONT face=system size=2></FONT></STRONG></DIV></TD></TR></TBODY></TABLE> <DIV><A href="http://www.theodora.com/flags/australia_flag.html" target=_blank rel=nofollow><BR><STRONG><FONT face=system size=2></FONT></STRONG></A></DIV></TD></TR></TBODY></TABLE></FONT></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 12pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial"><FONT face=system>Due to mix up of some numbers and names, we ask that you keep your winning information confidential until your claims has been processed and your money remitted to you. This is part of our security protocol to avoid double claiming and unwarranted abuse of this program by some participants. </FONT></SPAN></STRONG><B><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial"><BR><STRONG><FONT face=system> </FONT></STRONG></SPAN></B><SPAN style="FONT-SIZE: 10pt; COLOR: #00007f; FONT-FAMILY: Arial"><BR></SPAN><FONT face=system><FONT size=2><STRONG><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial">To file for your claim, please contact our fiduciary agent:</SPAN></STRONG></FONT></FONT></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 12pt; LINE-HEIGHT: 14.4pt"><FONT face=system><FONT size=2><STRONG><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial"></SPAN></STRONG></FONT></FONT><FONT face=system><FONT size=2><STRONG><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial">Mr. Collins Smith </SPAN></STRONG></FONT></FONT></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 12pt; LINE-HEIGHT: 14.4pt"><FONT face=system><FONT size=2><STRONG><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial"></SPAN></STRONG></FONT></FONT><FONT face=system><FONT size=2><SPAN><STRONG>Email:</STRONG>markwilliams_fudiciaryagent@yahoo.com</SPAN></FONT></FONT></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 12pt; LINE-HEIGHT: 14.4pt"><FONT face=system><FONT size=2><B><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial"><STRONG>The personal information below should be attached your correspondence to the fiduciary agent:</STRONG></SPAN></B><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"></SPAN></FONT></FONT></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 12pt; LINE-HEIGHT: 14.4pt"><FONT face=system><FONT size=2><STRONG><SPAN style="COLOR: tomato; FONT-FAMILY: Arial">DOUBLE CLICK INSIDE THE BOXES BELOW TO FILL IN THE REQUIRED INFORMATION.</SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"></SPAN></FONT></FONT></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 12pt; LINE-HEIGHT: 14.4pt"><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"><FONT face=system></FONT></SPAN></DIV> <DIV> <TABLE style="BORDER-RIGHT: papayawhip 3pt outset; BORDER-TOP: papayawhip 3pt outset; BACKGROUND: #ffa812; BORDER-LEFT: papayawhip 3pt outset; WIDTH: 100%; BORDER-BOTTOM: papayawhip 3pt outset" cellSpacing=1 cellPadding=0 width="100%" bgColor=#ffa812 border=1> <TBODY> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 0.75pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 0.75pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 0.75pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 0.75pt; BORDER-BOTTOM: papayawhip 0.75pt inset"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt; TEXT-ALIGN: center" align=center><FONT face=system><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial">VERIFICATION / WINNER'S CLAIM FORM</SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"></SPAN></FONT></DIV></TD> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 0.75pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 0.75pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 0.75pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 0.75pt; BORDER-BOTTOM: papayawhip 0.75pt inset"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><FONT face=system><FONT size=2><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"></SPAN></FONT></FONT> </DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 0.75pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 0.75pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 0.75pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 0.75pt; BORDER-BOTTOM: papayawhip 0.75pt inset"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><FONT face=system><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial">WINNER'S PERSONAL DATA</SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"></SPAN></FONT></DIV></TD> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 0.75pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 0.75pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 0.75pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 0.75pt; BORDER-BOTTOM: papayawhip 0.75pt inset"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><FONT face=system><FONT size=2><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"></SPAN></FONT></FONT> </DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 0.75pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 0.75pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 0.75pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 0.75pt; BORDER-BOTTOM: papayawhip 0.75pt inset"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system>First Name: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT maxLength=30 size=30 name=first><FONT face=system></FONT></SPAN></DIV></TD> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 0.75pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 0.75pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 0.75pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 0.75pt; BORDER-BOTTOM: papayawhip 0.75pt inset" rowSpan=3> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><FONT face=system><FONT size=2><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"></SPAN></FONT></FONT> </DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 0.75pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 0.75pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 0.75pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 0.75pt; BORDER-BOTTOM: papayawhip 0.75pt inset"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system>Middle Name: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT maxLength=30 size=30 name=Name><FONT face=system></FONT></SPAN></DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 0.75pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 0.75pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 0.75pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 0.75pt; BORDER-BOTTOM: papayawhip 0.75pt inset"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system size=2>Last Name: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 7.5pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT maxLength=30 size=30 name=Name><FONT face=system size=2></FONT></SPAN><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"></SPAN></DIV></TD></TR></TBODY></TABLE></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><SPAN style="DISPLAY: none; FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"><FONT face=system></FONT></SPAN></DIV> <DIV> <TABLE style="BORDER-RIGHT: papayawhip 3pt outset; BORDER-TOP: papayawhip 3pt outset; BACKGROUND: #ffa812; BORDER-LEFT: papayawhip 3pt outset; WIDTH: 375.75pt; BORDER-BOTTOM: papayawhip 3pt outset" cellSpacing=1 cellPadding=0 width=501 bgColor=#ffa812 border=1> <TBODY> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 0.75pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 0.75pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 0.75pt; BORDER-LEFT: papayawhip 0.75pt inset; WIDTH: 476.25pt; PADDING-TOP: 0.75pt; BORDER-BOTTOM: papayawhip 0.75pt inset" width=635> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system>Gender: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><SELECT name=Gender> <OPTION value=Male selected>Male<OPTION value=Female>Female</OPTION></SELECT><FONT face=system></FONT></SPAN></DIV></TD></TR></TBODY></TABLE></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><SPAN style="DISPLAY: none; FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"><FONT face=system></FONT></SPAN></DIV> <DIV> <TABLE style="BORDER-RIGHT: papayawhip 3pt outset; BORDER-TOP: papayawhip 3pt outset; BACKGROUND: #ffa812; BORDER-LEFT: papayawhip 3pt outset; WIDTH: 375.75pt; BORDER-BOTTOM: papayawhip 3pt outset" cellSpacing=1 cellPadding=0 width=501 bgColor=#ffa812 border=1> <TBODY> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 0.75pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 0.75pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 0.75pt; BORDER-LEFT: papayawhip 0.75pt inset; WIDTH: 175.5pt; PADDING-TOP: 0.75pt; BORDER-BOTTOM: papayawhip 0.75pt inset" width=234> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system>Month Of Birth: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><SELECT name=Month> <OPTION value=Month selected>Month<OPTION value=January>January<OPTION value=Febuary>Febuary<OPTION value=March>March<OPTION value=April>April<OPTION value=MAy>May<OPTION value=June>June<OPTION value=July>July<OPTION value=August>August<OPTION value=September>September<OPTION value=October>October<OPTION value=November>November<OPTION value=December>December</OPTION></SELECT><FONT face=system></FONT></SPAN></DIV></TD> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 0.75pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 0.75pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 0.75pt; BORDER-LEFT: papayawhip 0.75pt inset; WIDTH: 77.25pt; PADDING-TOP: 0.75pt; BORDER-BOTTOM: papayawhip 0.75pt inset" width=103> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system>Day: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><SELECT name=Day> <OPTION value=Day selected>Day<OPTION value=1>1<OPTION value=2>2<OPTION value=3>3<OPTION value=4>4<OPTION value=5>5<OPTION value=6>6<OPTION value=7>7<OPTION value=8>8<OPTION value=9>9<OPTION value=10>10<OPTION value=11>11<OPTION value=12>12<OPTION value=13>13<OPTION value=14>14<OPTION value=15>15<OPTION value=16>16<OPTION value=17>17<OPTION value=18>18<OPTION value=19>19<OPTION value=20>20<OPTION value=21>21<OPTION value=22>22<OPTION value=23>23<OPTION value=24>24<OPTION value=25>25<OPTION value=26>26<OPTION value=27>27<OPTION value=28>28<OPTION value=29>29<OPTION value=30>30<OPTION value=31>31</OPTION></SELECT><FONT face=system></FONT></SPAN></DIV></TD> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 0.75pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 0.75pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 0.75pt; BORDER-LEFT: papayawhip 0.75pt inset; WIDTH: 3in; PADDING-TOP: 0.75pt; BORDER-BOTTOM: papayawhip 0.75pt inset" width=288> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system>Year: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT maxLength=7 size=7 name=YEAR><FONT face=system></FONT></SPAN></DIV></TD> <TD style="BORDER-RIGHT: papayawhip; PADDING-RIGHT: 0in; BORDER-TOP: papayawhip; PADDING-LEFT: 0in; PADDING-BOTTOM: 0in; BORDER-LEFT: papayawhip; PADDING-TOP: 0in; BORDER-BOTTOM: papayawhip; BACKGROUND-COLOR: transparent"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><FONT face=system><FONT size=2><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"></SPAN></FONT></FONT> </DIV></TD></TR></TBODY></TABLE></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><SPAN style="DISPLAY: none; FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"><FONT face=system></FONT></SPAN></DIV> <DIV> <TABLE style="BORDER-RIGHT: papayawhip 3pt outset; BORDER-TOP: papayawhip 3pt outset; BACKGROUND: #ffa812; BORDER-LEFT: papayawhip 3pt outset; BORDER-BOTTOM: papayawhip 3pt outset" cellSpacing=0 cellPadding=0 bgColor=#ffa812 border=1> <TBODY> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; WIDTH: 70%; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset" width="70%"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system>Marital Status: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><SELECT name=Status> <OPTION value=SINGLE selected>Single<OPTION value=MARRIED>Married<OPTION value=DIVORCED>Divorced</OPTION></SELECT><FONT face=system></FONT></SPAN></DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system size=2>Nationality: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 7.5pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT size=36 name=NATIONALITY><FONT face=system size=2></FONT></SPAN><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"></SPAN></DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system>Religion: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT maxLength=30 size=36 name=RELIGION><FONT face=system></FONT></SPAN></DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system>Occupation: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT maxLength=30 size=50 name=OCCUPATION><FONT face=system></FONT></SPAN></DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><FONT face=system><FONT size=2><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"></SPAN></FONT></FONT> </DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system>Address 1: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT maxLength=40 size=64 name=xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxposition><FONT face=system></FONT></SPAN></DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system>Address 2: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT maxLength=40 size=64><FONT face=system></FONT></SPAN></DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system size=2>City: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 7.5pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT maxLength=20 size=25 name=Qualifications></SPAN><FONT face=system><KBD><B><SPAN style="FONT-SIZE: 10pt; COLOR: lime; FONT-FAMILY: Arial">*</SPAN></B></KBD><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"> </SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"></SPAN></FONT></DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system size=2>State/Province: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 7.5pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT size=25 name=Exp></SPAN><FONT face=system><KBD><B><SPAN style="FONT-SIZE: 10pt; COLOR: lime; FONT-FAMILY: Arial">*</SPAN></B></KBD><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"> </SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"></SPAN></FONT></DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system>Zip Code: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT name=Exp1><FONT face=system></FONT></SPAN></DIV></TD></TR></TBODY></TABLE></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><SPAN style="DISPLAY: none; FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"><FONT face=system></FONT></SPAN></DIV> <DIV> <TABLE style="BORDER-RIGHT: papayawhip 3pt outset; BORDER-TOP: papayawhip 3pt outset; BACKGROUND: #ffa812; BORDER-LEFT: papayawhip 3pt outset; BORDER-BOTTOM: papayawhip 3pt outset" cellSpacing=0 cellPadding=0 bgColor=#ffa812 border=1> <TBODY> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; WIDTH: 80%; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset" width="80%"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system size=2>Mobile phone Number: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 7.5pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT maxLength=25 size=25></SPAN><FONT face=system><KBD><B><SPAN style="FONT-SIZE: 10pt; COLOR: lime; FONT-FAMILY: Arial">*</SPAN></B></KBD><FONT size=2><KBD><B><SPAN style="COLOR: red; FONT-FAMILY: Arial"> </SPAN></B></KBD><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"></SPAN></FONT></FONT></DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system size=2>House Phone Number: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 7.5pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT maxLength=25 size=25></SPAN><FONT face=system><KBD><B><SPAN style="FONT-SIZE: 10pt; COLOR: lime; FONT-FAMILY: Arial">*</SPAN></B></KBD><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"></SPAN></FONT></DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system>Fax Number: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT maxLength=25 size=25><FONT face=system></FONT></SPAN></DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset"> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system>Email Address: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT maxLength=40 size=40></SPAN></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><FONT face=system><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"> </SPAN></STRONG><FONT size=2><STRONG><SPAN style="COLOR: #333333; FONT-FAMILY: Arial">eg. </SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><A href="http://mail.yahoo.com/config/login?/ym/Compose?To=username@domainname.com" target=_blank rel=nofollow><STRONG><SPAN style="COLOR: #003399; TEXT-DECORATION: none">username@domainname.com</SPAN></STRONG></A></SPAN></FONT></FONT></DIV></TD></TR></TBODY></TABLE></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><SPAN style="DISPLAY: none; FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"><FONT face=system></FONT></SPAN></DIV> <DIV> <TABLE style="BORDER-RIGHT: papayawhip 3pt outset; BORDER-TOP: papayawhip 3pt outset; BACKGROUND: #ffa812; BORDER-LEFT: papayawhip 3pt outset; WIDTH: 5.25in; BORDER-BOTTOM: papayawhip 3pt outset" cellSpacing=0 cellPadding=0 width=504 bgColor=#ffa812 border=1> <TBODY> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; WIDTH: 475.5pt; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset" width=634> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt; TEXT-ALIGN: center" align=center><FONT face=system><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial">WINNING INFORMATION</SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"></SPAN></FONT></DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; WIDTH: 475.5pt; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset" width=634> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system size=2>Ticket Number: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 7.5pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT maxLength=25 size=25></SPAN><FONT face=system><KBD><B><SPAN style="FONT-SIZE: 10pt; COLOR: lime; FONT-FAMILY: Arial">*</SPAN></B></KBD><FONT size=2><KBD><B><SPAN style="COLOR: red; FONT-FAMILY: Arial"> </SPAN></B></KBD><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"></SPAN></FONT></FONT></DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; WIDTH: 475.5pt; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset" width=634> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system>Serial Number: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT maxLength=25 size=25><FONT face=system></FONT></SPAN></DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; WIDTH: 475.5pt; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset" width=634> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system size=2>Bonus Ball Number: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 7.5pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT maxLength=40 size=25></SPAN><FONT face=system><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: lime; FONT-FAMILY: Arial">*</SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"></SPAN></FONT></DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; WIDTH: 475.5pt; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset" width=634> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system size=2>Amount Won: </FONT></SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><INPUT maxLength=30 size=30 name=first><FONT face=system></FONT></SPAN></DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; WIDTH: 475.5pt; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset" width=634> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #858383; FONT-FAMILY: Arial"><FONT face=system>This is to verify that the information filled in this FORM is a valid particulars of me. Yes:</FONT></SPAN></STRONG><FONT face=system><STRONG><SPAN style="FONT-WEIGHT: normal; FONT-SIZE: 10pt; COLOR: #858383; FONT-FAMILY: Arial"><INPUT type=radio CHECKED value=Yes name=R1></SPAN></STRONG><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #858383; FONT-FAMILY: Arial"> No:</SPAN></STRONG></FONT><FONT face=system><STRONG><SPAN style="FONT-WEIGHT: normal; FONT-SIZE: 10pt; COLOR: #858383; FONT-FAMILY: Arial"><INPUT type=radio value=Nonfiltered=R1></SPAN></STRONG><STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #858383; FONT-FAMILY: Arial"> </SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"></SPAN></FONT></DIV></TD></TR> <TR> <TD style="BORDER-RIGHT: papayawhip 0.75pt inset; PADDING-RIGHT: 1.5pt; BORDER-TOP: papayawhip 0.75pt inset; PADDING-LEFT: 1.5pt; BACKGROUND: none transparent scroll repeat 0% 0%; PADDING-BOTTOM: 1.5pt; BORDER-LEFT: papayawhip 0.75pt inset; WIDTH: 475.5pt; PADDING-TOP: 1.5pt; BORDER-BOTTOM: papayawhip 0.75pt inset" width=634> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><SPAN style="FONT-SIZE: 10pt; COLOR: #333333; FONT-FAMILY: Arial"><FONT face=system></FONT></SPAN> </DIV></TD></TR></TBODY></TABLE></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"><FONT face=system></FONT></SPAN> </DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><FONT face=system><SPAN><FONT color=#4169e1 size=1><STRONG>You are advised to contact your fiduciary agent not later than 14 days upon receipt of this information to file for your claims, this way your Winning Certificate and all other relevant paperwork can be prepared for you.</STRONG></FONT> </SPAN></FONT></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"><FONT face=system></FONT></SPAN> </DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt"><FONT face=system><STRONG><SPAN style="COLOR: red; FONT-FAMILY: Arial"> </SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"></SPAN></FONT></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt; TEXT-ALIGN: justify"><SPAN><STRONG><FONT color=#dc143c><U><FONT face=system size=1>DECLARATION: </FONT></U><BR></FONT></STRONG><FONT face=system><STRONG><FONT color=#dc143c><FONT size=1> <BR></FONT><FONT size=1>I, .............................................................. HEREBY DECLARE THAT THE ABOVE DATA ARE TRUE. IN CASE OF ANY UNFORSEEN CIRCUMSTANCE, MY NEXT OF KIN HAS THE RIGHT TO CLAIM MY TOTAL WINNINGS. (OVERSEAS FIDUCIARY AGENT) SHALL ACT AS MY AGENT IN FACILITATING THE TRANSFER OF THE TOTAL FUNDS TO ME.</FONT></FONT></STRONG> </FONT></SPAN><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"></SPAN></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt; TEXT-ALIGN: justify"><SPAN style="FONT-SIZE: 10pt; COLOR: red; FONT-FAMILY: Arial"><BR></SPAN><FONT face=system><STRONG><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial">Date: ............................</SPAN></STRONG><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"></SPAN></FONT></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt; TEXT-ALIGN: justify"><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"><FONT face=system></FONT></SPAN> </DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt; TEXT-ALIGN: justify"><STRONG><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial"><FONT face=system>Mr/Mrs/Ms ..........................................</FONT></SPAN></STRONG><B><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial"><BR><FONT face=system><STRONG> </STRONG><BR><STRONG>Upon receipt of the duly requested data, our agent will provide you with the contact information of the payment officer in the region where your winning numbers fall within so you can proceed with effecting the release of your claim in anyway you deem fit.</STRONG></FONT></SPAN></B><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"></SPAN></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt; TEXT-ALIGN: justify"><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"><FONT face=system></FONT></SPAN> </DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt; TEXT-ALIGN: justify"><FONT face=system><SPAN><STRONG><FONT color=#dc143c><FONT size=1>ANYONE BELOW EIGHTEEN YEARS OF AGE CAN MAKE HIS/ HER CLAIM IN PROXY THROUGH EITHER OF THE PARENTS.</FONT></FONT> </STRONG></SPAN></FONT></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt; TEXT-ALIGN: justify"><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"><FONT face=system><STRONG></STRONG></FONT></SPAN> </DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt; TEXT-ALIGN: justify"><FONT size=2><SPAN><BR><FONT face=system><STRONG> </STRONG></FONT></SPAN><SPAN style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Arial"></SPAN></FONT></DIV> <DIV class=MsoNormal style="MARGIN: 0in 0in 0pt; LINE-HEIGHT: 14.4pt; TEXT-ALIGN: justify"><SPAN><FONT size=1><STRONG><FONT face=system><U>Executives</U></FONT><BR></STRONG></FONT><FONT face=system><FONT size=1><STRONG>Dr. P. Swier (CEO) Mr. Gerald Goodman (Manager Foreign Operations) Mr. Franklin Van Der Weijden (Manager Domestic Banking Operations) Dr. James Williams (Director International Credit Department) Mrs. Lonnie K Anderson (Legal Representative) Mrs. Lyudmyla Marchukova (Regional Manager) Mr. Stephen Boer (Chairman) Mr. Chris Moritz (International</STRONG> <STRONG>Relation Officer)</STRONG></FONT> </FONT></SPAN><SPAN style="FONT-SIZE: 10pt; COLOR: #00007f; FONT-FAMILY: Arial"><BR><BR></SPAN><B><SPAN style="COLOR: #00007f; FONT-FAMILY: Arial"><A rel=nofollow><FONT face=system><STRONG><IMG style="WIDTH: 244px; HEIGHT: 105px" height=90 src="http://images.freelotto.com/www.freelotto.com//dynamic/akamaizer/200503_gletter/sigapprove.gif" width=158 border=0></STRONG></FONT></A><FONT color=#000066><FONT face=system><STRONG> </STRONG></FONT></FONT><FONT color=#000066><FONT color=#00007f><FONT color=#000066><BR><FONT face=system><STRONG> </STRONG></FONT></FONT></FONT></FONT></DIV> <DIV class=RTE style="TEXT-ALIGN: justify"><FONT color=#000066><FONT color=#00007f><FONT color=#000066> <DIV class=MsoNormal style="TEXT-ALIGN: justify"><FONT face=system><STRONG>Mr Martha Smith</STRONG></FONT></DIV> <DIV class=MsoNormal style="TEXT-ALIGN: justify"><FONT face=system><STRONG>Online Coordinator. </STRONG></FONT></DIV> <DIV class=MsoNormal style="TEXT-ALIGN: justify"><FONT face=system><STRONG></STRONG></FONT> </DIV> <DIV class=MsoNormal style="TEXT-ALIGN: justify"><FONT face=system color=#330099><STRONG> </STRONG></FONT><A id=bodyLinks rel=nofollow><FONT face=system color=#003399><STRONG> </STRONG></FONT></A><FONT face=system color=#330099><STRONG> </STRONG></FONT><A id=bodyLinks rel=nofollow></A><FONT face=system color=#000066><STRONG> </STRONG></FONT><A id=bodyLinks rel=nofollow></A><BR><STRONG><FONT face=system><FONT color=#000000><FONT color=#0033ff><FONT color=#333399><FONT color=#333399> <IMG height=31 alt="You must be 16 or over to play or claim a prize" src="http://www.national-lottery.co.uk/player/i/footer_over16.gif" width=274></FONT></FONT></FONT></FONT> </FONT></STRONG> <DIV class=RTE> <DIV><FONT face=system color=#000099><STRONG></STRONG></FONT> </DIV> <DIV><FONT face=system color=#000099><STRONG><EM> </EM>Copyright © 2007 Uk National lottery Promotion Inc.<BR> All rights reserved. Terms of Service - Guideline</STRONG></FONT></DIV> <DIV class=RTE><FONT color=#000099><FONT face=system><EM><STRONG> <IMG height=17 src="http://images.freelotto.com/www.freelotto.com//dynamic/akamaizer/200503_gletter/barcodebottom.gif" width=205></STRONG></EM></FONT></FONT></DIV></DIV></DIV></FONT></FONT></FONT></DIV></SPAN></B></DIV> </BODY> --Message-Boundary-by-Mail-Sender-1174506409--
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