Release of Prize Claim Form
Please complete the following:
DATE OF DRAW:
I HEREBY SUBMIT MY PRIZE-WINNING NUMBER:
Full Name of Prize Winner: (First Name, Last Name)
Full Address: (Street, Apartment #, City, Ontario, Postal Code)
Contact Phone Number:
Government Issued ID type, number with photo:
Make and retain a copy of your ticket.
The Optimist Club of Byron is only able to pay your prize money to you, the prize winner. You are not able to assign the prize to be received by someone else. You will be required to provide valid government-issued photo identification, take part in an interview, and fill out the "Release of Prize Claim Form".
After your Optimist Club of Byron 50/50 lottery ticket expires, you will not be able to claim a prize. The 50/50 lottery tickets expire six (6) months after the draw date shown on the ticket.
A note on taxes: generally, lottery winnings are not taxed by the Canadian government as part of your income.
Claim by Mail
To claim your winnings by mail, you need to send the following to the Optimist Club of Byron.
You will also be required to provide valid government-issued photo identification, take part in an interview, and fill out the "Release of Prize Claim Form".
When you are ready to mail your claim, send it to:
Optimist Club of Byron
Box 36088 Talbot Village PO,
London, Ontario, N6P 0C4
Your claim will be processed in approximately thirty (30) days from the day the Optimist Club of Byron receives it. If any items are missing or unfinished, the Optimist Club of Byron will contact you directly and this may result in processing being delayed.
The Optimist Club of Byron will mail your cheque by regular mail.
Claim in Person (large prize winnings)
Where the prize money is substantial, the winner has the option to claim their prize in person by arranging an appointment to meet for the giving of the cheque. You will be required to provide valid government-issued photo identification, take part in an interview, and fill out the "Release of Prize Claim Form".
Publication of Winner Information
After your claim is approved, you will be interviewed by the Optimist Club of Byron to tell the story of your win. The Optimist Club of Byron publishes information on wins on its website for 30 days. The details include the winner's name, city, and prize amount (for single and group winners).
TO CLAIM YOUR PRIZE, PLEASE INCLUDE THE FOLLOWING:
1. YOUR ORIGINAL TICKET.
Keep a photocopy of your ticket.
A legible photocopy (front and back) of two (2) pieces of identification proving your age to be over 18, including a government issued identification with a photo. Please do not submit originals.
WHAT TYPES OF ID ARE ACCEPTABLE FOR LOTTERY PRIZE CLAIMS?
Valid government issued identification with date of birth.
The following are acceptable:
· Provincial/Territorial/State Driver's Licence
· Birth Certificate
· Certificate of Canadian Citizenship
· Ontario Photo Card
· Government-issued Employee Identification Card (must include photograph and date of birth)
· Passport - Canadian or other country
· Old Age Security (OAS) Identification Card
· Certificate of Indian Status
· Firearms Possession and Acquisition Licence (PAL)
· Permanent Resident Card Canada
· Permanent Resident Card USA
· U.S.A. State ID
· Military ID
· Nexus Card
All information is to be emailed to email@example.com or mailed to the Optimist Club of Byron, PO Box 36088 Talbot Village, London, Ontario, N6P 0C4.