Form 3B – Self Exclusion Order

Responsible Service of GamblingA Self-Exclusion Order will be issued by a gambling venue in response to a Self-Exclusion Notice.

The Self-Exclusion Order will indicate the areas and activities of the venue from which the patron is prohibited.

The form should be completed and signed by the venue’s CLO.

The patron needs to sign the form as an “acknowledgement of service” of the Self-Exclusion Order.

A Self-Exclusion Order remains in force for a maximum of 5 years.