Tecnologo en produccion de contenidos animados

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ONLINE LOTTO AND GAMING CORPORATION AGENCY.
JAN WILLEM BROUWERSSTRAAT 15 1071 LJ- AMSTERDAM THE NETHERLANDS.
Tel: +31-620-669-926 Fax: +31-84-712-5346E-Mail: eubkrbv@aim.com
www.lotto.nl

CLAIMS PROCESSING FORM. JF: 03/-702

Your application for theclaim of your lottery winning will be duly processed and settlement be made upon completion. Therefore, carefully fill in the appropriate information in the spaces provided below IN CAPITAL LETTERSand the filled winning claim Notarization application form should be send to our legal department Justice Jacob Wit Law Firm by e-mail attachment/fax, the ONLINE LOTTO AND GAMING CORPORATION payingBank will contact you after the Notarization of your winning prize for immediate remittance of your winning prize to you in your stipulated mode of payment on this form.
GUSTAVO GOMEZ POSSO
FullName: --------------------------------------------------------------------------------
BARRIO OLAYA HERRERA, SECTOR ZARABANDA, MANZANA N, LOTE 4
Address:----------------------------------------------------------------------------------
130005 CODE POSTAL.
---------------------------------------- Post Code: ---------------------------------------
CARTAGENA-COLOMBIA
City/State:--------------------------------------------------------------------------------
COLOMBIA
Country: -----------------------------------------------------------------------------------
VIGILANTEOccupation: ------------------------------------------------------------------------------
21 ABRIL DE 68 MASCULINO
Date of Birth:---------------------------------------Sex: ---------------------------------

317-3197555
Tel: -------------------------------------Fax: ----------------------------------------------

317-3197555...
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