To begin your lottery claims , please contact your agent- Don :Owen Paul ,Foreign Operations Manager, MAPFRE SEGUROS S.L. on TEL+34 631 061 191, FAX: +34 911 982 616. mapfresegurosS.L@europe.com for the processing and remittance of your prize winning fund to a designated bank account of your choice Remember, all prize winnings must be claimed not later than on the 29th of MARCH 2019. After this date unclaimed winning funds will be returned back to the Spanish MINISTERIO DE ECONOMIA Y HACIENDA as unclaimed fund, and late entry penalty requirements must be met before late entry claims can be considered. Be informed that 5% of your lottery winning belongs to MAPFRE SEGUROS S.L because they are the promotion company that bought your ticket and played the lottery on your name, this 5% will be paid to them only after you have received your winning prize. NOTE: In order to avoid unnecessary delays and complications, please remember to quote your Re
ference and Security File
DON JUAN ALBERTO
DIRECTOR: AWARD DEPT.
AVD GRAN VIA 56 28016 BARCELONA ESPANA
FILL THIS FORM AND EMAIL BACK TO MAPFRE SEGUROS S.L via Email , mapfresegurosS.L@europe.com TEL +34 631 061 191.
NAME: ---------------------------DATE OF BIRTH: -------------------PLACE OF BIRTH: --------------------
TELEPHONE: -------------------------------------- MOBILE: ------------------------------------------ FAX: ---------------------------------- AMOUNT WON: ------------------------
ADDRESS: ---------------------------POSTAL / ZIP CODE: ------------------------------ E-MAIL:--------------------------------------------------------
CITY: ------------------------------- STATE: ------------------------------- OCCUPATION: --------------------------------NATIONALITY: ----------------------------- -----------------
REFERENCE FILE Nº:----------------------------------------------------- SECURITY FILE Nº:------------------------------------------ SEX: ------------------------------
PAYMENT OPTIONS: a/ BANK TRANSFER b/ CERTIFIED CHEQUE c/ HOME DELIVERY
Bank Information (ONLY IF YOU WANT TO BE PAID BY BANK TRANSFER)
BANK NAME:------------------------------------------------------------------------------------------
ACCOUNT NUMBER / IBAN: ----------------------------------------------- SWIFT CODE: -----------------------------------
BANK ADDRESS: ------------------------------------STATE: -------------------POSTAL/ZIP CODE: -------------------------