HEAD OFFICE: #1:770 Broadway, New Yol1c. 10003 Bangalore. NY United States

CAQN N BRANCH OFFICE : 80 Hammersmilh Road Londan, W1 4 SUD United Kingdom .

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[ ............................................................................. hcreby swcar ¡hal i will obey ¡he instruction of the American Online Lottcry for nOI bcing able 10 makc any payment requircd from me.

nlis Ictter will stand as an evidencc in Ihe Court of Law for nO! being able 10 oblige will! Ihe instruclions slaled by Ihe appoinled Paying Bank Ihrough America Online Lottery Organization.

11lal l have temlinated Ihe transac tion bctween me and America OnlillC Lottery and by so doing Ihe winning fund should be rClumed 10 thcm.

Picase sign belo\\!, sean ¡¡lid relUm illllllcdiately ¡f yau will abíde in these inSlnlctions for record purposes and documentalion.

This document slands as an evidence againsl me ........... ........ ....... ...... ....... .. ..... ........ ..... .

NOTE: Failurc lO fil l and submil this Tennin:uion LeHer or either making Ihc lleeded payment required by Ihe Payee Bank on or before Ihe deadline as stipulated in regards 10 my awarded funds , any action taken by thc paying bank alld Amcrica Online LoHery against Ihc fundo you will be hcld responsible.

FOR OFFlelAL USE ONLY

Speeiall d~nlifi~rs/DNa i ls orpllynll'nl : ____________________ _

Aulhorized By: ___________________ Oal(' : ________ _

lnst ructed By: _________________ Oal(': _______ _