Gambling exclusion forms
Publication and resources
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Form 3A - Self-exclusion noticePDF
Individuals seeking to self-exclude from a venue or gambling activity must complete Form 3A and provide it to the gambling provider/s.
Form 3B - Self-exclusion orderPDF
On receipt of Form 3A, the gambling provider completes Form 3B and gives it to the individual as an acknowledgement of their self-exclusion.
Form 3C - Revocation notice - self-exclusion orderPDF
Individuals seeking to cancel self-exclusion must complete form 3C and lodge it with the gambling provider. Form 3C can only be lodged within the initial 24-hour cooling-off period, or 1 year after the exclusion was lodged by the...
Form 3D - Exclusion directionPDF
The gambling provider completes Form 3D and gives it to the individual to exclude them from a venue or gambling activity. Also refer to Form 3I.
Form 3E - Application to revoke exclusion ...PDF
Individuals seeking to cancel venue-initiated exclusion must complete form 3E and lodge it with the gambling provider. Form 3E may only be lodged 1 year after the exclusion commenced. Only 1 application may be lodged in any 12-month...
Form 3F - Revocation notice exclusion directionPDF
On receipt of Form 3E, the gambling provider completes Form 3F and gives it to the individual to confirm the cancellation of the venue-initiated exclusion. For cancellations only. Also refer to Form 3J.
Form 3G - Register of excluded personsPDF
The gambling provider record the details of individuals who have been excluded from their venue or from gambling activities at the venue on Form 3G.
Form 3H - Notice of contravention of ...PDF
The gambling provider completes Form 3H if an individual breaches a self-exclusion order or exclusion direction; and lodges it with the Office of Liquor and Gaming Regulation.
Form 3I - Information notice exclusion directionPDF
The gambling provider completes Form 3I and gives it to the individual with Form 3D, to provide information about why the exclusion has been issued. Also refer to Form 3D.
Form 3J - Information notice refusal to revoke ...PDF
On receipt of Form 3E, the gambling provider completes Form 3J and gives it to the individual to provide information about why the gambling provider has refused to cancel the exclusion. For refusals only. Also refer to Form 3F.
Form 3R - Report on excluded personsPDF
The gambling provider completes Form 3R and lodges it with the Office of Liquor and Gaming Regulation, who must receive it not later than 14 days after 30 June and 31 December each year.
Remote self-exclusion authority and ...PDF
Complete this form to authorise the Gambling Help service to act as your representative when consenting to seek a remote self-exclusion from a gaming venue.
Step by step remote self-exclusions guide for ...PDF
Gambling Help services should follow this guide to help a person remotely self-exclude from a gaming venue.
Additional information
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Justice and Attorney-General, Queensland Government, Gambling exclusion forms, licensed under Creative Commons Attribution 3.0 sourced on 05 December 2020
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