Self Exclusion - Online Form

Program information

Self Exclusion Program at Crown

Assessing your current situation and giving us an indication about your circumstances will help us understand you better.

The information you provide below supports this application as well as any future applications for revocation of your Self Exclusion.

You must provide responses to the below questions.

Important information:

By completing this Request for Self Exclusion, you elect to Self Exclude from Crown Casinos or both Crown and The Star Casinos. This Request for Self Exclusion will be followed by the issuance of Self Exclusion Order.
For Crown - You will be prohibited from entering or remaining in the Crown Sydney VIP Casino operated by Crown Sydney Gaming Pty Ltd (‘Crown Sydney’), the casino operated by Crown Melbourne Limited (‘Crown Melbourne’) and the casino operated by Burswood Nominees Limited (‘Crown Perth’) (each a ‘Crown Casino’) We will inform Star Casino Group as we are required to by law. Star may act to exclude you.
If you elect to Self Exclude from both Crown and The Star Casinos, you must upload the NSW Casinos Self Exclusion Form, duly witnessed by an authorised person.
Crown is required by law to inform The Star Casinos of your exclusion, even if you only elect to Self Exclude from Crown Casinos.

Checklist

I wish to make this Self Exclusion (application). In making this application, I acknowledge and agree to the following*

<a href="/responsible-gaming-melbourne/making-a-change/terms/terms-and-conditions" target="_blank">T&Cs</a> <a href="/responsible-gaming-melbourne/making-a-change/terms/privacy-collection-statement" target="_blank">Privacy Collection Statement</a> Yes, I have also completed, signed/witnessed and scanned all necessary documents ready for digital upload

Part 1 of 5 – Required documents upload

What is your home property?*

Crown Melbourne Crown Sydney Crown Perth

What type of Self Exclusion are you choosing? *

I want to exclude from Crown I want to exclude from Crown & The Star (both Identification and NSW Casino Self Exclusion forms required)

ID Self-Verification Photo (<a href="/getmedia/9df02778-d8ea-466f-8772-ce4837603b11/230831-Crown-Resorts-RSG-ID-Verification-Sample-Headshot.jpg" target="_blank" rel="noopener noreferrer">download sample</a>)*

Scanned photo ID*

Recent High-resolution Headshot Photograph*

NSW Casinos Self Exclusion document (<a href="/getmedia/a0460d32-388e-4c65-bc5e-178545a1c236/Crown-Melbourne-Responsible-Gaming-Casinos-Self-Exclusion-Online-Form.pdf?ext=.pdf" target="_blank" rel="noopener noreferrer">download here</a>)

Part 2 of 5 – Personal information

First name*

Middle name

Family name*

Current residential address*

Email*

Email confirmation*

Phone / mobile*

Date of birth*

Crown membership number (if applicable)

Part 3 of 5 – Playing profile

1. How did you become aware of the Self Exclusion process?

2. Where do you normally play and what games do you play?

3. When would you normally attend?

4. How many hours do you usually play per week and how many days a week do you attend?

5. Do you understand that you are prohibited from making any wager in the Crown Sydney VIP Casino under section 86A of the Act, and that any winnings paid or payable to you will be forfeited to Crown Sydney under section 86A(2) of the NSW Casino Control 1992 Act, and paid into the Responsible Gambling Fund?

Yes, I understand

Part 4 of 5 – About your exclusion

6. Have you previously excluded yourself from any other Gaming Operators?*

No Yes

If yes, where & when?

7. Why do you wish to be excluded from Crown Casinos?

8. Have you discussed your gambling with a family member, friend or professional and did this help?

9. What impact has gambling had on your life?

10. What impact has gambling had on your relationships?

11. Have you ever borrowed money to gamble? How much and from who?

12. Do you currently have a gambling related debt? How much and from where?

13. Do you have any credit card debt?

14. You will be issued with an Exclusion Order which prohibits you from entering and remaining in the Casino at Crown Melbourne pursuant to section 72 of the Casino Control Act 1991 (VIC) and Crown Perth under section 26(2) of the Casino Control Act 1984 (WA) and Crown Sydney pursuant to section 79(3) of the Casino Control Act 1992 (NSW).