About your purchase Claim form

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Claim form
To claim your Samsung Reward, please complete and return this form. It s important that ALL fields marked* are completed, as failure to do so may delay your claim. Alternatively you can submit your claim online at:
www.samsung.com/uk/promotions/rewardyourself

About your purchase
Date of purchase*
Store of purchase*
TV Model*

Completed forms must arrive no later than 28 days from the date of the additional products being purchased with a final closing date of 22nd February 2013.
Terms and conditions apply.
Completed forms must arrive no later than 28 days from the date of the additional products being purchased.
Mr/Ms/Mrs*

Serial Number*
2nd Samsung Product Serial Number.*

3rd Samsung Product Serial Number (if applicable).

First Name*
(Including Middle Name Initial*)

4th Samsung Product Serial Number (if applicable).

Surname*

Date of Birth

House Name or Number*

Street*

Finding your model code and serial number
The model code and the serial number can be found on the reverse of your TV on a small white label - the model code will generally start with UE or PDP and the serial number is a 15 digit code starting Z8 or Z9.
For all other Samsung product serial numbers please refer to the support section at:
www.samsung.com/uk/support/help/modelfinder_popup.html
Please tick to confirm the following: