Affidavit of Eligibility for Contest or Sweepstakes

Affidavit of Eligibility for Contest or Sweepstakes

Before you use this: Enter the eligibility conditions from the promotion's official rules. Check whether the sponsor requires its own form or a particular notarial certificate. Complete the facts before signing, and have the oath or affirmation administered by an authorized notarial officer.

State of [STATE]

County of [COUNTY]

Promotion and affiant

I, [FULL LEGAL NAME], being duly sworn or affirmed, state as follows:

1. I am the person identified above. I entered the promotion identified above on [__/__/____] by [DESCRIBE ENTRY METHOD].
2. I have read the official rules identified above, including their eligibility conditions. I make the factual statements below so the Sponsor can determine whether I qualify for the identified prize.
3. The official rules require [INSERT THE EXACT AGE OR DATE-OF-BIRTH CONDITION]. My date of birth is [__/__/____], and I satisfy that condition because [STATE FACTS].
4. The official rules require [INSERT THE EXACT RESIDENCE OR LOCATION CONDITION]. My residence is [CITY, STATE, COUNTRY], and I satisfy that condition because [STATE FACTS].
5. The official rules exclude [INSERT EMPLOYEE, FAMILY, HOUSEHOLD, OR OTHER RELATIONSHIPS, IF ANY]. I am [STATE RELEVANT RELATIONSHIP OR LACK OF ONE] with respect to the Sponsor and the persons listed in those rules.
6. The official rules impose these additional eligibility conditions: [LIST EACH APPLICABLE CONDITION OR WRITE "NONE"]. My facts relevant to each condition are [STATE FACTS; ATTACH A SEPARATE SHEET IF NEEDED].
7. My entry was submitted in my name and with my authorization. The information I supplied with the entry was [ACCURATE / CORRECTED AS FOLLOWS: __________].
8. I have disclosed to the Sponsor any fact that could affect my eligibility: [DESCRIBE OR WRITE "NONE KNOWN"].

I have read this affidavit. The statements above are true to the best of my personal knowledge, except where I expressly identify another source. I understand that the Sponsor will use these statements to check my eligibility under the identified official rules.

Affiant signature: [________________________________]

Printed name: [________________________________]

Date: [__/__/____]

Attachments, if any: [________________________________]

Notarial certificate

[NOTARIAL OFFICER: COMPLETE OR ATTACH THE JURAT REQUIRED WHERE THE OATH OR AFFIRMATION IS ADMINISTERED. RECORD THE DATE, VENUE, AFFIANT, SIGNATURE, TITLE, AND SEAL AS REQUIRED THERE.]

Source reference

The FTC DetectaRobo Official Rules, § 9 provide an official example of a sponsor requiring an affidavit of eligibility to verify a potential winner. This affidavit uses the promotion's own official rules to state the applicable conditions.