PAYEESRECEIPT

ReceivedfromtheDirectorofStateLotteries,Thiruvananthapuramasum
of Rs ...................... (Rupees ............................................................. only) after
deductingincometax@30% Rs...................(Rupees...........................................
only) from prize amount of Rs ............................(Rupees ................................
only) and after deducting agents prize @10% Rs ..........................
(Rupees...............................................................only)fromtheprizeamountofRs
......................(Rupees....................................only)duetome againstTicketNo,
..............................whichhaswonthe.............prizeofthe............................draw
ofKeralaStateLotteriesheldon.....................

SignatureonRevenueStampworthRe.1/
Name&FullAddresswithPINCODE.