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Hoang Loi Ngoc Nguyen EX-399 4139-2015

Create: Thu, 07/13/2023 - 22:12

Author: admin

Hoang Loi Ngoc

Nguyen

EX-399

4139-2015

Tue, 09/22/2015 - 20:00

hoang_nguyen.pdf113.66 KB

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NAME OF INDIVIDUAL FILING A DISPUTE OR COMPLAINT

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HOME ADDRESS:

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PHONE NUMBER:

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DATE AND APPROX TIME OF INCIDENT:

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USER/SCREEN NAME USED:

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Please provide a summary of the incident or dispute to the best of your knowledge. Include any statements which you made to the licensed gaming entity's personnel or any statements you made to witnesses to the incident or dispute.

Please provide a summary of the incident or dispute to the best of your knowledge. Include any statements which you made to the licensed gaming entity's personnel or any statements you made to witnesses to the incident or dispute.

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