Prize Claim Form Barbados Lottery

PRIZE CLAIM FORM
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City

Country
Tel Number *
Please enter a valid phone number.
Mobile Number
Please enter a valid phone number.
Email
example@example.com
ID Type *

National ID Driver's License # Passport #
ID # *
Gender *

Male Female Prefer not to say
Age *
Payment Preference *

Cheque Direct Deposit
Name as Appears on the Account
Account Number
Bank
Branch
Transit Number
Should be Empty: