Prize Claim Form

Prize Claim Form

Please don't fill this out if you've won Vortex Cash - This will be credited automatically
Personal Details
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Address*

Street Address

Street Address Line 2

CityCountry

Post Code
Email*
example@example.com
Phone Number*
Prize
Order Number
Prize Won*
Verification and Payment
Upload a copy of your Government issued photo ID*

e.g, Passport or Drivers License, if none available, please take a clear photo of yourself holding a sign with your name on it - Challenge 25 will be applied
Cancelof
PrizeCash
What is the advertised cash alternative that you have agreed to take? (if there is one advertised)
Bank transferPayPal
Name on Bank Account
Account Number
Sort Code
Or
PayPal Email Address or Username
Only include this if you want to be paid via PayPaL
By my signature, I indemnify Vortex Competitions Ltd for any loss which may
result if any of the foregoing information is not true and accurate.
Under penalty of perjury, I declare that to the best of my knowledge and belief:
1. The name and address which I have provided, correctly identify me as the
recipient of this payment
2. No other person is entitled to claim this prize
3. I am not a person disqualified by law from claiming and/or accepting this prize
4. I am over 18 years of age
Enter you full name as your signature
Date*

DayMonthYear
Payments are made as soon as this form is received, however, please allow 24 hours before contacting us.
Should be Empty:

Personal Details