Gamingform Claims UK
We help clients across the UK with gamingform claims on a no win no fee basis where eligible.
Letter of Authority
Guidance Notes
Please write clearly in the white spaces with capital letters or cross the boxes. Once complete please submit
or return in the prepaid envelope provided.
1
Your Details
Title
First Name
Initials
Last Name
Date of birth (dd/mm/yyyy)
Contact Number
Email address
------ 2nd Applicant (only complete if joint account) ------
Title
Fi
rst
Name
Initials
Last Name
Date of birth (dd/mm/yyyy)
2
Y
our Address
Addr
ess Line 1
Previous Address (if moved i
n the last few yea
rs)
City
Postc
ode
3
Y
ou
r Claim
Bettin
g Company/Pla tform
Customer’s Username
To whom it may concern
Your
Si
gnature
Main
Ap
plicant
2
nd
Applicant
Date
Date
I/We
he
reby appoint and authorise Ingram Toft to act on my/our behalf with respect to my/our gambling/be
tti
ng
complaint and
claim
for
compensation
on
betting
and
gambling
payments.
I/We
further
authorise
Ingram
Toft
to submit
a
Subject
Access
Requ
es
t on my/our behalf under Section 7 of the Data Protection Act 2018.
I/We
co
nfirm that I/we have lawfully contracted with Ingram Toft and request that you comply with any requ
es
t for
information
they make on my/our behalf, whether by telephone or in writing (including e-mail or online submissions). I/We
confirm that
Ingra
m
Toft have full delegated authority to act on my/our behalf and settle my/our claim without further rev
ert
i
ng to
myse
lf/ourselves. This instruction covers all payments and bets related to all accounts I/we hold with yourselv
es
.
Ingra
m Toft is a trading name of LS Claims Ltd which is
r
egulated by the Financial Conduct Authority in resp
ect of Regulated
Claim
s
Management activities (FCA no: 831386) Registered Office: 13
th
Floor, Piccadilly Plaza, Mancheste
r,
M1 4BT
. Vat No:
287011704.
