I ,The Manager of the ..................................................
BANK,.................................Branch solemnly affirm that, the proceeds of Ticket No................. of Lottery No................ ,will be credited to the account of the Prize Winner Shri/Smt...................................................on realisation. I also authorise the Director of State Lotteries to pay the proceeds of the above said lottery to the ........................................... Bank, .............................. Branch who is acting as a collecting bank of us.
Name & Signature of the Manager.
Place: Date: Seal
NB: Please refer the file number in all correspondence.