Lottery Application Form

	Title *
	Surname *
	Forename(s) *
	Member no
	Warrant/Payroll/Man. No
	How many chances (at £1 per chance and up to 10 chances) would you like each month? *
	Please note: If you are paid 4 weekly, one deduction will remain in your savings each year as there are 13 deductions but 12 lotteries.
	Please tick here to confirm that you understand that the same amount of pounds sterling as you have chosen chances will be either deducted from your payroll or direct debit contribution each month until you tell us otherwise. *