Gambling-related exclusion forms and signs
If you need help completing any of these forms, contact the Office of Liquor and Gaming Regulation (OLGR).
Individuals seeking to self-exclude from a venue or gambling activity must complete form 3A and give it to the gambling provider(s).
On receipt of form 3A, the gambling provider must complete form 3B and give it to the individual as an acknowledgement of their self-exclusion.
Individuals seeking to cancel self-exclusion must complete form 3C and lodge it with the gambling provider.
Form 3C can only be lodged:
|Venue-initiated exclusion forms|
The gambling provider must complete form 3D and give it to the individual to exclude them from a venue or gambling activity (also complete form 3I).
Individuals seeking to cancel venue-initiated exclusions must complete form 3E and lodge it with the gambling provider. (Gambling providers must then complete either form 3F (revocation notice) or form 3J (refusal).)
Form 3E can only be lodged 12 months after the exclusion commenced. Only 1 application can be lodged by a patron in any 12-month period.
On receipt of form 3E, the gambling provider must complete form 3F and give it to the individual to confirm the cancellation of the venue-initiated exclusion. (Complete form 3J instead, if you refuse the application.)
The gambling provider must complete form 3I and give it to the individual with form 3D, to provide information about why the exclusion has been issued (complete with form 3D).
On receipt of form 3E, the gambling provider must complete form 3J and give it to the individual to provide information about why they have refused to cancel the exclusion. (Complete form 3F instead, if you approve the application.)
|Breach or contravention forms|
The gambling provider completes form 3H if an individual breaches a self-exclusion order or direction, and lodges it with OLGR.
|Reporting forms (for gambling providers)|
Record the details of individuals who have been excluded from your venue or from gambling activities at your venue on form 3G.
Complete form 3R and lodge it with OLGR no later than 14 days after 30 June and 31 December each year.
Self-exclusion signage for gambling venues
Self-exclusion signage reminds gamblers they can ban themselves if their gambling is too much to cope with.
Download the following signs and brochures for use in your venue:
- Exclusion information brochure
- Exclusion sign (standard)
- Exclusion sign (name and photo)
- Exclusion sign (name only)
- Self-exclusion in effect? It's illegal to enter
- Entering with self-exclusion in effect is against the law
- Gambling Help Service phone numbers poster
- Gambling Help takeaway contact card (folded wallet card)