Shop&Dine@SMRT – Lucky Draw Form

Please complete ALL fields indicated with an asterisk (*)

(Incomplete forms will be considered null for lucky draw)

Winners are required to present the original receipt(s) as proof of purchase

Personal Information
Card Type :
*NRIC / FIN / Passport No. :

*Full Name :
*Primary Contact No. :
Secondary Contact No. :
Email Address :
 
Others Information
*Date of Purchase
AprMay 2012Jun
SunMonTueWedThuFriSat
293012345
6789101112
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20212223242526
272829303112
3456789
*Shop Location
*Shop Name
*Amount ($)  
Citibank SMRT Platinum Visa card