This application allows you to create a request to self-exclude yourself from areas within a registered club and/or hotel where poker machines and/or electronic gaming machines are present.
It is strongly recommended that prior to completing this application, you discuss this matter with your counsellor, legal advisor and members of your family if you have not already done so.
To make an application for self-exclusion, you are required to agree to the terms of the MVSE Operator’s Self-Exclusion Agreement and Personal Information Collection Notice. You can access a copy of the Self-Exclusion Agreement here and Personal Information Collection Notice here. If you are unsure about the effect or meaning of the Self-Exclusion Agreement, please obtain independent legal advice prior to submitting this application.
Once you have completed this application, please click the “Submit” button. If the application contains any errors or is incomplete, you will be notified at the time you click the “Submit” button and will be unable to submit the application until all errors are resolved and all required information is provided. Once the application is submitted, you will receive an email notification from the MVSE Operator confirming receipt of the application. Your application will then be assessed by the MVSE Operator.
If your self-exclusion request is approved, you will receive a notification titled “Self-Exclusion Order” from the MVSE Operator via the email address you provide in the application. If there are any issues with your application preventing the MVSE Operator from approving your self-exclusion request, the MVSE Operator will contact you to help fix those issues. Your self-exclusion is not effective until the MVSE Operator issues a Self-Exclusion Order to you.
An application allows you to exclude from up to 35 venues. Should you require more venues, you must contact MVSE Counsellors on 1800 99 77 66. Any further applications submitted will not be processed.
Please note that if your self-exclusion request is approved, it will only operate to exclude you from the areas within your nominated venue or venues where poker machines and/or electronic gaming machines are present. It does not allow you to exclude yourself from an entire venue. If you want to exclude yourself from an entire venue, please contact the MVSE Operator at [email protected] or 1800 99 77 66.
Please note this application requires you to upload the following documents for identification purposes:
- a clear photo of you holding a copy of your Australian state or territory issued Driver Licence, photo card or passport; and
- a scanned copy of your Australian state or territory issued Driver Licence, photo card or passport; and
- a recent high-resolution headshot photo of your face.
Please have this information ready to upload before you start this application. This application cannot be saved and resumed later.
You must not submit this application for any other person but yourself.