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How to use or fill out Self-Exclusion Form (CGCC-037, Rev. 07/17) with DocHub
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Click ‘Get Form’ to open the Self-Exclusion Form in our editor.
Begin by filling out Section 1: Personal Information. Enter your full legal name, any other names you may have used, and your contact details including home and business numbers.
In Section 2, indicate your desired term of exclusion by initialing next to either 'Lifetime' or 'One Year'.
Complete Section 3: Photo and Visual Description. Provide your date of birth, race/ethnicity, hair and eye color, height, weight, and affix a recent passport-quality photograph.
In Section 4: Declaration, read through the statements carefully. Initial each statement to confirm your understanding and agreement.
If required, complete Section 5 for notarization or witness signature before submitting the form as instructed.
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If you think youre spending too much time or money gambling, you can volunteer to ban yourself from in-person or online gambling for a set length of time. This is called self-exclusion. In this time, you will not be able to gamble within the companys venue, or on their website or app.
What is the time limit for self-exclusion?
You can ask a gambling company to stop you betting with them for a set length of time usually between six months and five years. This is called self-exclusion.
How do I self-exclude myself?
If someone wants to self-exclude, they usually have to sign an agreement that lists which venues they want to be banned from for a certain amount of time. Depending on the venue, they might be excluded from the whole venue, gaming areas, or certain gambling activities.
What is the process of self-exclusion?
Self-exclusion is when you ban yourself from a gambling venue (or part of a venue) or online wagering service for a period. Self-exclusion is an important tool for dealing with gambling harm (in addition to seeking help from a Gambling Help service).
Can I take myself off self-exclusion?
How to Remove Yourself from Self-Exclusion. If youve docHubed the end of your self-exclusion period, you may want to know how to remove yourself from self-exclusion. This requires submitting a self-exclusion removal request to the gambling operator or program you initially signed up for.
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Self-exclusion involves voluntarily registering to be temporarily or permanently blocked from going to certain places where people can gamble, like clubs, pubs, TABs or casinos. By law, all Australian gambling providers must give customers the option to self-exclude if they want to.
Related links
CGCC-GCA-2017-01-N
(a) Licensees shall implement a program that allows patrons to exclude themselves from gambling establishments using a form entitled Self-Exclusion Request,
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