1. Confirmation Number:
In the space below, type the confirmation number that was given when you applied.
2. Last / Family Name:
Provide the primary entrant name exactly as entered on the Diversity Visa Lottery Form, including punctuation. If no name was provided, select the option labeled, "No Family/Last Name" below.
3. Year of Birth:
Provide the year of birth for the primary entrant.
4. Authentication
Type the characters as they appear in the picture.
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