Application for Agency under Kerala State Lottery (1) Name and address: (Name of Post Office,District and State should be clearly shown) (2) Age and Date of Birth: (3) Business/Profession: (4) Amount remitted with details of Remittance(Chalan No. & date/Postal M.O.Receipt No. & date/Postal Order No./Bank Draft No. & date) (5) Office from which issue of tickets is desired(Directorate of state Lotteries/District Lottery Office.) I have read and understood Kerala State Lottery Rules. I agree to abide by those rules and also to abide by all direction, instrucion or orders issueid y the Director of state Lotteries from time to time. Place: Date: Signature of applicant.
