Garena Account Retrieval Form

Greetings,

This is to certify that I

Arpit Singh Parihar

(First, Middle and Last Name)

, hereby sign

this disclaimer form on this day

29/10/2013 , and currently residing at

(DD/MM/YYYY)

Flat no. 4,

Ameet apartments, model colony, Pune,India. Is the rightful owner of the Garena
(Permanent Address)

Account arpitsingh_7 with User ID#: ????????.

(Username) (UID or Unique Identification Digits)

I also have agreed to attached my Government college ID for verification of my Identity and
(Type of ID)

documentation purposes for the account I am retrieving.

Arpit Singh Parihar

Signature over Printed Name

October 29, 2013

Date Signed