Pala Win Loss Statement Form PDF Details

The Pala Win Loss Statement form plays a crucial rule in the interaction between patrons and the Pala Casino Spa Resort, catering to a need for transparency and legal compliance within the gaming industry. Federal laws necessitate that casinos obtain written consent from an account holder before releasing any financial data related to their gambling activities. This form is designed as an instrument to secure such approval, ensuring the safeguarding of personal information while adhering to legislative requirements. It outlines various modes of delivery for this sensitive information, including mail, email, and pick-up options, but notably excludes telephonic communication to preserve data integrity. With a clear directive that information will only be shared with the person whose name and other specified details appear on the form, it builds a framework for privacy and accountability. The form requires personal details, including part of the Social Security Number, address, and signature, further emphasizing the importance of security and individual authorization. It also specifies a timeframe for the release of information, placing the responsibility on the requester to provide accurate and verifiable details to prevent any misuse or misdirection of financial statements or W2G Reports. This approach not only respects the individual's rights but also aligns with the casino's dedication to promoting responsible gaming and adhering to federal regulations.

QuestionAnswer
Form NamePala Win Loss Statement Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesPalaCasinoSpaResort, 2013, Temecula, SSN

Form Preview Example

Pala Casino Spa Resort

PMB 40

35008 Pala Temecula Road

Pala, CA 92059

Delivery Options:

Mail

Email

Pick-up

Faxed

Dear Sir or Madam:

As required by Federal legislation, as well as considering our guests’ best interest, prior to releasing any financial information we must receive written approval from the owner of the account, which we maintain. This letter will serve to fulfill that requirement allowing us to send, in written form, the information requested by you on your account.

We will not provide information to you on a spouse, family member, relative, friend or other account, without written approval from the holder of that account.

Please complete the lower portion of this document, including information to be released, address to send the information to, signature and date. This form will serve as a waiver for the release of information, only to the person and address listed below, for a period of one year from the date of signature.

Information will not be provided over the phone. All information will be mailed, e‐mailed or faxed to:

Print Name:

 

 

 

 

 

 

Last 4 digits of SSN:

 

Address:

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

State:

 

 

Zip:

 

 

Birth Date:

 

 

 

Privilege Player No:

 

 

E-mail:

 

 

 

 

 

 

 

 

 

 

 

 

Phone:

 

 

 

Fax:

 

 

 

 

 

 

*Signature:

 

 

 

 

 

 

 

Date:

 

 

Requested Information (Please check):

Win/Loss Statement (Specify year)

W2G Report (Specify year)

*Please allow up to 10 business days to process. Pala Casino Spa & Resort (PCSR) will not be held responsible for misdirected W2G reports. The signature above releases PCSR from all liability. Signatures can and will be verified prior to the release of any W2G information. If discrepancies are identified, PCSR has the right to require additional validation information from the requestor.

Please Return this Form to Pala Casino Spa Resort

Attn: Regulatory Compliance Department, at the address above

This form may also be FAXED to 760‐510‐5194

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This document requires particular details to be typed in, hence make sure to take whatever time to fill in what is expected:

1. You will need to fill out the Temecula properly, therefore be mindful while working with the sections comprising all these blank fields:

Part no. 1 of completing PCSR

2. Right after this part is completed, go on to enter the suitable information in all these: Email, Phone, Fax, Signature, Date, Requested Information Please check, WinLoss Statement Specify year, WG Report Specify year, Please allow up to business days, Please Return this Form to Pala, Attn Regulatory Compliance, and This form may also be FAXED to.

Part # 2 for filling out PCSR

Those who work with this PDF generally make errors while filling in Please Return this Form to Pala in this area. Ensure you read again what you type in right here.

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