Gambling-related exclusion forms and signs

Form 3A—self-exclusion notice

Individuals seeking to self-exclude from a venue or gambling activity must complete form 3A and give it to the gambling provider(s).

Form 3B—self-exclusion order

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.

Form 3C—revocation notice—self-exclusion order

Individuals seeking to cancel self-exclusion must complete form 3C and lodge it with the gambling provider.

Form 3C can only be lodged:

• within the initial 24-hour cooling-off period after submitting form 3A (cancellation takes effect immediately once you receive the revocation notice)
• 12 months after the exclusion was originally lodged (cancellation takes effect 28 days after you receive the revocation notice).

Form 3D—exclusion direction

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).

Form 3E—application to revoke exclusion direction

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.

Form 3F—revocation notice—exclusion direction (approval)

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.)

Form 3I—information notice—exclusion direction

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).

Form 3J—information notice—refusal to revoke an exclusion direction

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.)

Form 3H—notice of contravention of self-exclusion order/exclusion direction

The gambling provider completes form 3H if an individual breaches a self-exclusion order or direction, and lodges it with OLGR.

Form 3G—register of excluded persons

Record the details of individuals who have been excluded from your venue or from gambling activities at your venue on form 3G.

Form 3R—report on excluded persons

Complete form 3R and lodge it with OLGR no later than 14 days after 30 June and 31 December each year.