prize claim form

CONGRATULATIONS
ON BEING A WINNER!
This form is required by all winners claiming a prize that
cannot be paid at an SA Lotteries Outlet. Some Retailers
may pay prizes higher than $500 at their discretion
(an Outlet’s payout limit is authorised by SA Lotteries).
Prizes over $5,000 are processed at SA Lotteries Head
Office upon submission of a Prize Claim Form in person
or by post.
To claim your lottery, Keno or Instant
Scratch-Its prize, complete the following
steps:
1. Complete the Prize Claim Form
FF
FF
FF
FF
Section 1: Fill in your personal details.
Section 2: Fill in your bank details.
Section 3: Sign the Claimant Declaration.
Section 4: Provide details of lottery, Keno or
Instant Scratch-Its ticket/s.
FF Take a photocopy of the Prize Claim Form for
your records.
PRIZE CLAIM
CONDITIONS
Claiming first division lottery prizes and
Keno Spot 9 and Spot 10 prizes
First division, Keno Spot 9 and Keno Spot 10 prizes are
available for payment from the first business day two
weeks following the draw.
PRIZE CLAIM
FORM
Claiming other division lottery prizes
Lower division prizes are available the first business
day following the draw, with the exception of The Pools
where prizes are available the Tuesday after the draw.
For more information or enquiries
please contact SA Lotteries
Address����������������������������188 Richmond Road,
Marleston, SA 5033
Office Opening Hours�������8:30am – 4:30pm, Monday to Friday
Phone��������������������������������131 868 during business hours
Phone Business Hours�����8am – 5pm, Monday to Saturday
8am – 2pm, Sunday
Email���������������������������������� [email protected]
2. Sign ORIGINAL winning lottery, Instant
Scratch-Its or Keno ticket/s
FF Write your name, address and signature on the
back of the ORIGINAL winning lottery, Keno or
Instant Scratch-Its tickets.
FF Take a photocopy of your winning ticket/s for
your records.
3. Submit Prize Claim Form in person or
by post.
SA LOTTERIES OFFICE USE ONLY
CORPORATE INFORMATION
RECORDS MANAGEMENT
Date received
Congratulations on being an
SA Lotteries winner!
FF In person – Visit 188 Richmond Road,
Marleston, SA 5033, during office hours.
FF By post – SA Lotteries recommends using
Registered Post for added security. Mail Prize
Claim Form and original winning ticket/s to:
• Administration
PO Box 74
Marleston, SA 5033
salotteries.com.au
The information in this guide is current at time of printing in September 2014
and this information is subject to the Lotteries (General) Rules available online at
www.salotteries.com.au.
SEPTEMBER 2014
Gamble responsibly
Gambler’s Help 1800 858 858.
OFFICE USE ONLY
(please print clearly)
Email Address
Postcode
Date
/
I confirm that I am not
an owner or staff
member of an SA
Lotteries Agency.
/
NOTE: Owners or staff members
of an SA Lotteries Agency must
refer to Retailers Web for
information on claiming a prize.
For all enquiries please phone our
National Lotteries Contact Centre on
131 868.
Payment made pursuant to the
claim, if any, will be made by bank
transfer to the name and bank
account of the claimant shown.
Please contact SA Lotteries to
enquire about any additional
payment directives relating to
multiple claimants. If the claim is
rejected the claimant will be notified.
IMPORTANT NOTICE
Please indicate your answers by marking the
check boxes with a .
—
Account No.
Account Name
NOTE: Any changes or
alterations including whiteout
to bank details must be
initialled by the claimant.
To the best of my knowledge and belief all of the information in this
claim is true and correct;
I am over the age of 18 years; and
I am the rightful owner of the attached lottery, Keno or Instant
Scratch-Its ticket/s.
I understand that SA Lotteries maintains the right to disqualify a ticket or decline to pay a
prize in the case of fraud or as otherwise outlined under the SA Lotteries (General) Rules.
Claimant Signature
•
XL – X Lotto
Oz – Oz Lotto
S66 – Super 66
SPL – The Pools
TOTAL $
ISI – Instant Scratch-Its
Prize Amount
(if known)
Cheque No.
Payment Method:
EFT
Amount
TIL
Processed By
Claim Entered By
No. of Lottery Tickets Received
Signature
/
Claim Received By
/
Date Claim Received
Free Tickets
Other
Signature
provide details below
Payment Authorised By
/
/
Cheque –
Date Processed
Claim Verified By
No. of Instant Scratch-Its Received
/
Date Authorised
/
Claim ID Number
SEPTEMBER 2014
The personal information collected from you in this document is sought by Tatts Lotteries SA Pty Ltd ABN 41146245007, a member of the Tatts Group Limited. The collection of your name and address is required under the SA
Lotteries (General) Rules and will be used to register, verify and pay your prize. We may not be able to process your claim unless you provide this information to us. Your information may be disclosed to third parties including
your and our financial institutions, our selling outlets, our contractors (such as IT providers or mail services), our professional advisors, gaming and other regulators, legal enforcement agencies or as required by law. Our Privacy
Policy, available at www.salotteries.com.au, contains further information about how you may access and seek a correction of your personal information, and how you may complain about privacy related matters and how your
complaint will be dealt with. For privacy related queries, please contact 131 868 or [email protected].
KCT – Keno Coin Toss
K – Keno
Lottery or Keno or Instant Scratch-Its Ticket Number
MWXL – Monday & Wednesday X Lotto
PBL – Powerball
Draw No.
(lotto & Keno only)
Collection of personal information
*Game:
Game
(see below)*
Please include with this Prize Claim Form all ORIGINAL lottery tickets / Instant Scratch-Its / Keno tickets as listed below in an envelope. It is important you
include your name, address and signature on the back of ALL lottery, Keno or Instant Scratch-Its tickets. Processing may take up to 10 working days. Registered
Post is recommended. Mail to ADMINISTRATION, PO BOX 74, Marleston SA 5033, Australia.
(please print clearly)
Out of Date Tickets – If you are making a claim on an out of date ticket please complete this Prize Claim Form along with an Ex Gratia Statutory Declaration available on the
SA Lotteries website.
Lost or Destroyed Tickets – If you are making a claim on an unregistered lost or destroyed ticket please only use the Lost/Damaged Ticket Search form available on the SA
Lotteries website.
4. Lottery Ticket / Instant Scratch-Its Ticket / Keno Ticket Details
•
•
An Ex Gratia Claim is a claim for a prize on a ticket that is out of date or is a winning unregistered ticket that has been lost or destroyed and has been forfeited to the SA
Lotteries Commission.
Ex Gratia Claims
•
•
•
I hereby claim payment for any prizes associated with the attached lottery, Keno or Instant Scratch-Its ticket/s and I declare that:
3. Prize Claim Form Declaration – Claimant’s Declaration
Branch (BSB) No.
Branch Address
Financial Institution Name
Please provide your bank details for direct deposit of your prize payment:
Inaccurate or incomplete bank account details may lead to the payment being delayed or rejected by your financial institution. In the event that
the funds transfer is rejected, a cheque may be issued in lieu.
2. Payment of Prize Claim
Easiplay Club
Card number
(if applicable)
Daytime Phone No.
Address
Claimant Name/s
1. Claimant Details
ADMINISTRATION, PO BOX 74, Marleston, SA 5033, Australia.
Complete sections 1, 2, 3 and 4 below and mail to
PRIZE CLAIM FORM
Please photocopy this form and your winning
lottery, Keno or Instant Scratch-Its ticket/s for
your personal records before sending the
original ticket/s and form to SA Lotteries.
Send completed Prize Claim Form to SA Lotteries. Include ONLY ORIGINAL lottery / Keno / Instant Scratch-Its ticket/s.