Gambling and Racing Control (Code of Practice) Approved form AF2002-235

Approved by the Commission on 27 November 2002 under the 
Gambling and Racing Control Act 1999, section 53D   

Gambling and Racing Control (Code of Practice) Regulations 2002 — Form 1
(Sch 1, Cl 13)
Australian Capital Territory

Deed of Exclusion

This Deed of Exclusion is made on the ……… Day of …………….…....200…..

BETWEEN the Applicant:

…………………………………………………..
Name of Person seeking exclusion

………………………………………………….

…………………………………………………..

Address of Person seeking exclusion

AND the licensee of the Gambling Facility:

…………………………………………………..
Name of Gambling Facility

………………………………………………….

…………………………………………………..

Address of Gambling Facility

Chapter 1	INTERPRETATION

In this Deed:

“Applicant” means the person requesting the Deed of Exclusion be executed.

“Licensee” 	means the licensee of a gambling facility as defined in Regulation 5 of the Regulations and/or its servants, agents and legal representatives.

“Gambling Facility” means the facility identified in the preamble to the Deed.

“Commission” means the ACT Gambling and Racing Commission established under Part 2 of the Gambling and Racing Control Act 1999.
Chapter 2	OPERATIVE CLAUSES

Pursuant to Clause 13 of the Gambling and Racing Control Code of Practice (“the Code”) contained in Schedule 1 of the Gambling and Racing Control (Code of Practice) Regulations 2002 (the “Regulations”), the Applicant agrees to abide by the following provisions:

1.	I understand and request that exclusion from the above-named facility remains in force for a period of …………………………  (effective from the date of execution of this Deed).

2.	I agree not to seek entry to or attempt to enter or utilise or attempt to utilise the Gambling Facility for the duration of this Deed.

3.	I understand that the licensee may remove me from, or prevent me from entering, the Gambling Facility and I authorise the licensee to prevent me from entering or to remove me from the Gambling Facility.

4.	I agree to provide the licensee with a photograph and other identification sufficient to enable the licensee to identify me.

5.	I authorise the licensee to retain and display or disseminate a copy of my photograph and other details and to allow access to that material for the purpose of identification by the licensee but not for access or display to the general public.

6.	I understand that pursuant to clause 18 of the Code my personal details and the details of the exclusion will be placed on a Register held by the licensee.

7.	I understand that if I hold an account with the Gambling Facility that the licensee will not allow me or anyone else to use that account for the duration of the Deed.

8.	I understand that exclusion by this Deed is voluntary and does not place any obligation, duty or responsibility on any other person or body other than myself and I further understand that the Deed is not a contract and it in no way binds the licensee. 

9.	I agree to release, and covenant not to sue the Commission, the gaming operators or the licensees or their servants, agents, contractors and the legal representatives of such persons (“the released persons”) from all actions, suits, claims, demands whatsoever, but for this Deed, could now or hereafter be asserted, brought or made by me, or by anyone on my behalf, arising from any damage or injury or otherwise cause directly or indirectly as a result of any act, default, omission of the released persons in relation to the matters contained in this Deed.

10.	
I acknowledge that the contents of this Deed have been read and explained to me and I accept the effect of the Deed and the obligations, duties and/or responsibilities placed on me by the matters set out in the Deed.

…………………………………            ………………………………
         Applicant                                        Licensee of Gambling Facility