Self Exclusion Form

Your Details

Title

First name

Last name

Your Email

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Your Phone number

Postcode

County

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Address line 2

Town or city

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Please exclude me from all lottery and raffle activity with immediate effect. I understand that by submitting this form, the exclusion will remain in place until I telephone to tell you that I wish to begin gambling again. Please note that by law the self-exclusion must apply for a minimum period of 6 months.

If I attempt to enter the lottery or a raffle during the term of this exclusion and am identified by a member of staff, I will be refused entry and any stake will be returned to me. I acknowledge my responsibility in ensuring adherence to this agreement. I acknowledge that the Promoter, its employees or agents have no liability or claims arising from my voluntary use of the gambling facilities provided.

If you would like further support visit GambleAware; GamCare or call the National Gambling Helpline on 0808 8020 133.

Contact Information