One97 Communications Limited

B-121, Sector- 5, Noida- 201301

PRIZE REDEMPTION FORM FOR “MOVPHONE” CONTEST

(Please read instructions overleaf)

PLEASE FILL IN WITH CAPITAL LETTERS

________________________ ________________________ ____________________________

1. FIRST NAME 2. MIDDLE NAME 3.SURNAME

4. DATE OF BIRTH (dd-mm-yyyy): ________________ (Attach Copy of age Proof)*

5. GENDER (M/F): _______

6. RESIDENCE ADDRESS: ______________________________________________________________

______________________________________________________________

CITY ____________ STATE ________________ PIN CODE ______________

7.PAN No.: _______________ Postpaid Mob.No.: ________________ Prepaid Mob. No.: ______________
(Pls. Attach Copy)* (Pls. Attach Copy of Bill)*

8. E-MAIL ADDRESS: ________________

9. Winner of WEEKLY/MONTHLY/Bumper PRIZE: _________________________________

10. ATTACH PROOF OF IDENTITY: ______________

(PASSPORT COPY/ RATION CARD /VOTERS ID CARD / PAN CARD / DRIVING LICENCE)

 I hereby solemnly declare that I have read & understood the instructions posted on website
(https://paytm.com/offer/winbig/ ) and agree to all the terms & conditions stated therein. I hereby
further state that
(a) I am over the age of 18 years;
(b) I was an active and existing subscriber at the time of competition;
(c) I have been neither prosecuted nor convicted for committing any criminal offence or abetment
thereof;
(d) I am not suffering from any legal disability e.g. insolvency, restraint by court etc;
(e) I do not have any outstanding dues payable to Aircel Operator on account of the mobile
connection

and the information supplied above are true and correct to my knowledge. I undertake to be liable
for any falsity in information provided or misrepresentations made herein and agree to bind myself to
any penalty that One97 Communications Limited (“Company”), in its sole discretion may impose,
including forfeiting the prize redemption and submit to the liability under Indian laws. I agree that by
signing this form and redeeming the prize, my name, locality, other personal information and the
prize amount would become public information.

Date: (dd-mm-yyyy) ________________ Redeemers Signature: __________________

*Applicable for Weekly/Monthly/Bumper prize winner.