Gambling and Racing Control (Code of Practice) Approved form AF2002-236

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 2
(Sch 1, Clause 14)
Australian Capital Territory

Exclusion from Gambling by Licensee

To:	………………………………………………
Name of Person excluded

	………………………………………………

	………………………………………………
Address of Person excluded

Pursuant to Clause 14 of the Gambling and Racing Control Code of Practice contained in Schedule 1 of the Gambling and Racing Control (Code of Practice) Regulations 2002 you are excluded from the following gambling facility effective as of the date on this notice:

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

……………………………………………………
……………………………………………………
Address of Gambling Facility

This exclusion has been made by me following consideration of the following matters:
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

As a result of this exclusion:

1.	you will not be permitted to utilise the above Gambling Facility;
2.	the gambling licensee and/or its agents will remove you from, and prevent you from entering the Gambling Facility; and
3.	if you have an account with the Gambling Facility, the account will be closed and the balance owing returned to you.

Should you wish for this decision to be reviewed pursuant to Regulation 16 of the Gambling and Racing Control (Code of Practice) Regulations 2002, you may apply in writing to the ACT Gambling and Racing Commission (PO Box 214, Civic Square, ACT, 2608).

Notice made on the …………………. Day of ………………………. 200…….

…………………………………….
         Licensee of the Gambling facility