Home
About BetSafe
Evaluation
Help for Gamblers
Resources
Contact
Online Self-Exclusion Form
Self-Exclusion from NSW Clubs & Hotels
BetSafe can assist you to self-exclude from up to 10 NSW clubs and hotels in 2 easy steps:
Complete the request for self-exclusion form below, making sure all of the information you enter is correct.
Follow the instructions and complete the self-exclusion documentation which is sent to you by person-to-person registered post.
Your details
Please enter your full name (as it appears on your photographic identification)
Given Name/s:
Surname:
Date of Birth: (dd/mm/yyyy)
Contact Phone Number:
Email Address:
Residential address
Address:
Suburb:
State:
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Postcode:
Postal address (if different to residential address)
Address:
Suburb:
State:
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Postcode:
Identification
We require a clear copy of a current photographic identification document in order to allow us to verify that the photo which you provide is you. Accepted photographic identification documents are Driver's Licence, Rider's Licence, Proof of Age Card and Passport. If you have a change of address label on the rear of your Driver's Licence, please provide a copy of both sides.
Upload of scanned copy of your photographic identification (2mb limit).
I will send a photocopy my photographic identification when returning the self-exclusion documentation.
I do not have any photographic identification (you will be required to complete a declaration in order to prove your identity)
.
Photo
We require a recent photo (within the past 6 months) of you in order to assist the venue/s to enforce your exclusion.
Upload a digital photo (2mb limit)
.
I will send a photo when returning the self-exclusion documentation.
Nominated Venues
Please nominate each venue which you want to self-exclude from on a separate line (limit of 10 venues).
Exclusion Period
Nominate the minimum period for your self-exclusion:
6 months
1 year
2 years
3 years
4 years
5 years
6 years
7 years
Terms & Conditions
I understand that BetSafe will send me the documentation required to self-exclude to my residential address (or postal address, if specified) by person-to-person registered post.
I understand that I will not be self-excluded from the nominated venues until each venue receives the relevant forms and implements the exclusion.
I understand that whilst BetSafe will take all steps necessary to notify the nominated venues, BetSafe will take no responsibility for documentation that has been lost in transit or failure to notify the nominated venues.
I understand that the nominated venues may not be under any obligation to accept my request for self-exclusion. Whilst BetSafe may take reasonable steps to notify me if a venue is not willing to accept my request for self-exclusion, BetSafe makes no undertaking that I will be notified in this event.
I understand that I can contact the nominated venues directly to confirm whether my request has been processed or to arrange self-exclusion if the documentation provided by BetSafe is not accepted.
I understand that the nominated venues may send a letter to me confirming receipt of my request for self-exclusion.
I understand that if I do not follow the instructions provided by BetSafe, or these terms and conditions, that the nominated venues may not be notified of my request for self-exclusion.
I understand that each of the nominated venues may have policies, procedures and/or requirements that I must adhere to in order to terminate my self-exclusion. I understand that I may remain excluded from the nominated venues until I satisfy their requirements for terminating my self-exclusion.
I fully indemnify BetSafe and will not hold BetSafe liable for anything resulting from them agreeing to process this request for self-exclusion.
I agree to the Terms & Conditions.
