Request for Self-Exclusion Form

The information you provide below supports this application as well as any future applications for revocation of your self-exclusion.

IMPORTANT INFORMATION BEFORE YOU START

By completing this request for self-exclusion, you are requesting to self-exclude from all The Star Casinos, or both The Star Casinos and Crown Casinos. This request for self-exclusion will be followed by the issuance of an exclusion order.
For The Star Casinos – You will be excluded and prohibited from entering or remaining in The Star Sydney Casino of 80 Pyrmont Street, Pyrmont NSW 2009; The Star Gold Coast Casino of 1 Casino Drive, Broadbeach QLD 4218; and The Star Brisbane Casino of 33 William Street, Brisbane City, QLD 4000 (together, The Star Casinos).
If you request to self-exclude from both The Star Casinos and Crown Casinos, you will be excluded and prohibited from entering or remaining in the Crown Sydney VIP Casino of 1 Barangaroo Avenue, Sydney NSW 2000; Crown Melbourne Casino of 8 Whiteman Street, Southbank VIC 3006; and Crown Perth Casino of Great Eastern Highway, Burswood WA 6100, (together, Crown Casinos).
The Star Sydney Casino is required by law to inform Crown Sydney VIP Casino of your exclusion, even if you only elect to self-exclude from The Star Casinos. Crown Casinos may act to exclude you.
Self-exclusion orders will be sent by registered mail to the current residential address you provided.

* Indicates Required Field

Checklist and Consent

I wish to make this self-exclusion application. In making this application, I acknowledge and agree to the following.

View Self Exclusion Terms and Conditions

I Accept Self Exclusion Terms and Conditions

View Self Exclusion Online Privacy Collection Statement

This includes information on our use of Facial Recognition Technology.

I Accept Privacy Collection Statement

Part 1 of 5 – Self Exclusion Request

What type of Self Exclusion are you choosing?

I want to exclude from The Star Casinos

I want to exclude from The Star Casinos and Crown Casinos

Part 2 of 5 – Personal Information

Family name

Given name(s)

Date of birth

Current residential address

Postcode

State

Mobile number

Email Address

Star Club Account Number (If applicable)

Part 3 of 5 – Your Play Profile

At which of The Star Casinos do you normally play?

What games do you normally play?

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

Part 4 of 5 – About Your Self-Exclusion

I am requesting to be self-excluded for the following reasons:

You will be issued with a self-exclusion order which prohibits you from entering and remaining in the casino at The Star Gold Coast and The Star Brisbane pursuant to section 91N of the Casino Control Act 1982 (QLD) and a voluntary exclusion order which prohibits you from entering and remaining in the casino at The Star Sydney pursuant to section 79 of the Casino Control Act 1992 (NSW).

Yes, I understand

Part 5 of 5 – Your Self-Exclusion Application

In accordance with the Privacy Collection Statement, I agree to provide a recent photo taken within the last six months and copy of identification to confirm my identity.

Yes, I understand and agree

I agree to sign, arrange to witness and return the completed documents to The Star Casinos.

Yes, I understand and agree

Open Request for Self Exclusion for The Star Casinos/Crown Casinos

I understand and agree this application is made voluntarily

Yes, I understand and agree

The information contained in this application is correct.

Yes, I confirm