|
DEED OF SELF EXCLUSION
| THIS
DEED made on
the ___________day of
_________, relevant year
by , |
| Date
Of Birth: ____________ of _________________ in |
| the
State of VICTORIA |
This program is based
on the principle of self-help whereby a person wants to stop themselves
from playing gaming machines.
Self-exclusion is
available for persons who voluntarily exclude themselves from entering
gaming rooms and from playing gaming machines at nominated hotels and
clubs. Any person who is prepared to sign this Deed of Self-exclusion
makes a commitment not to play gaming machines at nominated gaming venues.
Persons undertaking
Self-exclusion agree to undertake problem gambling counselling.
This Deed of
Self-exclusion authorises management of the nominated venues to take any
reasonable steps to ensure persons signatory to a Deed of Self-exclusion
do not enter the restricted gaming areas or play the gaming machines.
WHEREAS:
| 1. |
I believe
that I have a problem controlling my use of gaming machines at the
gaming venue at:
1) Venue A
2) Venue B
3) etc
(We
usually suggest patrons choose 6 - 12 gaming venues that are near
their home or their work, or on a regularly traversed route. Some
people only need to list one venue and some people need more than
twelve. You will need to be able to name the venues for us to
include them in your deed.)
|
| 2. |
I
desire to deny myself the right of entry to and to exclude myself
from areas at the Venue/s set aside for gaming purposes only (Restricted
Gaming Areas) and to deny myself the right to use gaming machines
at the Venue/s (such exclusions and denials hereafter called "Self
Exclusion").
|
| 3. |
I
desire the Australian Hotels Association Victoria (hereafter called the "Industry
Body"), the Licensee of the Venue/s and/or their servants or
agents to take such action as is necessary to prevent me from entering
the Restricted Gaming Areas and using gaming machines at the Venue/s
and to remove me from such restricted Gaming Areas.
|
| 4. |
I
understand that Self Exclusion from Restricted Gaming Areas at the
Venue/s is made voluntarily and does not place any obligation, duty
or responsibility on anyone except myself.
|
| 5. |
I
understand and accept that upon signing and lodging this document
with the Industry Body, I become self excluded from the Venue/s and
as such I will not enter any Restricted Gaming Areas or use any gaming
machine at the Venue/s (Self Excluded Person).
|
| 6. |
I understand and accept that upon signing and lodging this document
with the Industry Body, I become ineligible to participate in
any
gaming-related loyalty program administered by a gaming venue and /or
a gaming machine operator for the period of self exclusion. I
authorise the Industry Body to forward details of my Self Exclusion to Tattersalls Gaming Pty Ltd and Tabcorp Holdings Pty Ltd.
|
| 7. |
I
understand and desire that Self Exclusion from the Venue/s will remain
in force for a minimum period of six (6) months, and will expire on
the _________________ [Period of Self Exclusion].
|
UNDERTAKINGS
|
| 8. |
I UNDERTAKE that I will, during the Period
of Self Exclusion:
| a) |
consider
myself as a Self Excluded Person;
|
| b) |
not
withdraw or revoke any undertakings, authorities, release, covenant
and/or indemnity contained in this Deed;
|
| c) |
not
enter the Restricted Gaming Areas at the Venue/s and will not
use the gaming machines at the Venue/s;
|
| d) |
immediately
stop using gaming machines and/or leave the Restricted Gaming
Areas at the Venue/s at the request of the Industry Body, the
Licensee of the Venue/s and/or their servants or agents;
|
| e) |
seek
and continue to seek the assistance and advice of a Problem
Gaming Counsellor; and
|
| f) |
Not
seek to become a member of
any gaming-related loyalty program administered by a gaming
venue and/or a gaming machine operator.
|
|
AUTHORITY
|
| 9. |
I
AUTHORISE the Industry Body, the Licensee of the Venue/s and/or their
servants or agents during the Period of Self Exclusion:
|
| |
| a) |
to ask
me to immediately stop using gaming machines and/or to immediately
leave the Restricted Gaming Areas at the Venue/s;
|
| b) |
if I
refuse to immediately stop using gaming machines and/or to
immediately leave the Restricted Gaming Areas at the Venue/s, to
take such action as is necessary to remove me from such Restricted Gaming Areas
and/or the Venue/s and to stop me using any gaming machine at
the Venue/s; and
|
| c) |
to take
such other action as the Industry Body, the Licensee of the
Venue/s and/or their servants or agents deem necessary to prevent me from entering the
Restricted Gaming Areas and from using gaming machines at the
Venue/s and to remove me from such Restricted Gaming Areas and/or
the Venue/s.
|
|
| 10. |
I AUTHORISE the Industry Body to take my photograph.
|
| 11. |
I
AUTHORISE the Industry Body to retain a copy of my photograph and
all records relating to my Self Exclusion and to deal with such copies
and records as it sees fit in connection with the Industry Body's
Self Exclusion program, including the anonymous collection of data
by the Industry Body. I further authorize the Industry Body to notify
Tattersalls and Tabcorp (Gaming Operators) of my undertaking of Self
Exclusion in order that my name and address may be deleted from their
mailing list to enable them to cancel any entitlements to any of the
Gaming Operators promotions.
|
| 12. |
I
AUTHORISE the Industry Body, the Licensee of the Venue/s and/or their
servants or agents, within the Period of Self Exclusion, to retain
and display my photograph and name at the Venue/s in an area accessible
to Venue staff and not the general public for the purpose of allowing
Venue staff to identify me as a Self Excluded Person, AND I FURTHER
AUTHORISE the use of the photograph for this purpose.
|
| 13.
|
I
AUTHORISE the Industry Body to advise
Tattersalls and /or Tabcorp of the details of
my Self Exclusion, and I AUTHORISE gaming venues,
Tattersalls and Tabcorp to do all things necessary
to remove me from any gaming-related loyalty program .
|
| 14. |
I
understand and accept that although I give the above authorities there
is no obligation, duty and/or responsibility on the Industry Body,
the Gaming Operators, the Licensee of the Venue/s and/or their servants
or agents to undertake any or all of the actions or things so authorised.
|
RELEASE
|
| 15. |
I and my administrators and assigns HEREBY RELEASE AND COVENANT NOT TO
SUE the Industry Body, the Gaming Operators, the Licensee of the
Venue/s, their nominees, servants, agents, contractors
(including the legal personal representatives of any such persons) and
the Victorian Commission for Gambling Regulation (VCGR) (the Released Persons)
from all actions, suits, claims and demands whatsoever which, but
for this document, 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 caused directly or indirectly as a result of any act,
default or omission of the Released Persons in relation to this Self
Exclusion, including but not limited to:
|
| |
| a) |
the
display, keeping and dissemination of photographs and records
relating to my Self Exclusion;
|
| b) |
any
interviews with me relating to Self Exclusion;
|
| c) |
preventing
me from entering the
Restricted Gaming Areas of the Venue/s and/or the Venue/s, from
using gaming machines at the Venue/s, removing me from Restricted
Gaming Areas and/or the Venue/s, and stopping me using gaming
machines at the Venue/s; and
|
| d) |
wholly
or in part failing to act upon or respond to my desire for and
my undertakings and/or authorities in respect of my Self Exclusion.
|
|
| 16. |
I
accept that the Industry Body, the Licensee of the Venue/s, their
nominees, servants or agents, contractors and/or legal personal representatives
and the VCGR
may plead this release and covenant not to sue as an absolute bar
to any and all actions, suits, claims and demands made by me my administrators
and assigns or on my behalf whether made now, proceeding, or hereafter
arising directly or indirectly in any way whatsoever out of my Self
Exclusion.
|
INDEMNITY
|
| 17. |
I
and my administrators and assigns now and will at all times in the
future INDEMNIFY AND KEEP INDEMNIFIED the Industry Body, the Gaming
Operators, the Licensee of the Venue/s, their servants or agents,
nominees, contractors, and the legal personal representatives of such
persons and the VCGR (the Indemnified Persons) against all actions, liabilities,
proceedings, losses, claims, damages, costs and expenses which the
Indemnified Persons may suffer, incur or sustain in connection with
or arising directly or indirectly from any act, default or omission
by or on behalf of the Indemnified Persons in relation to my Self
Exclusion.
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ACKNOWLEDGMENTS
|
| 18. |
I ACKNOWLEDGE THAT:
|
| |
| a) |
the
contents of this document have been read to me by the Industry
Body at my Self Exclusion interview held on _______________
day of ______________ relevant year
;
|
| b) |
I understand
and accept the effect, obligations, duties and/or responsibilities
on me and my administrators and assigns created by this document,
including the undertakings, authorities, release, covenant,
indemnity and acknowledgments;
|
| c) |
the
Industry Body, the Gaming Operators, the Licensee of the Venue/s
and/or their servants or agents make no assurances to me of
confidentiality in respect to any matter connected with my Self
Exclusion, including the display of my photograph and name and/or
the keeping and/or dissemination of records and any other information
relating to my Self Exclusion;
|
| d) |
my Self
Exclusion will remain in force and will not be withdrawn during
the Period of Self Exclusion;
|
| e) |
the
Self Exclusion process is entirely voluntary involving voluntary
undertakings by me (but which are enforceable against me) and
is not a contract and does not require any action or responsibility
by and in no way binds the Industry Body, the Gaming Operators,
the Licensee of the Venue/s, their nominees, servants or agents,
contractors and/or legal personal representatives;
|
| f) |
it is
not my intention to create any legal duty, obligation or responsibility
on the Industry Body, the Gaming Operators, the Licensee of
the Venue/s and/or their nominees, servants or agents, contractors
and/or legal personal representatives;
|
|
REVOCATION
AND TERMINATION
|
| 19.
|
Notwithstanding
paragraphs 6 and 7 above, I may revoke this Self Exclusion but only:
|
| |
| a) |
after
the expiration of a minimum period of six (6) months from the
commencement of the Period of Self Exclusion;
|
| b) |
by
arranging and attending another interview with the Industry
Body;
|
| c) |
by producing
written evidence that I have received counselling from a qualified
Problem Gaming Counsellor in respect of revocation of Self Exclusion;
and
|
| d) |
after
signing and lodging with the Industry Body the Deed of Revocation
of Self Exclusion.
|
|
| 20. |
At
the expiration of the Period of Self Exclusion or upon revocation
in accordance with paragraph 17 above, my Self Exclusion shall be
at an end and I may thereafter enter Restricted Gaming Areas and use
the gaming machines at the Venue/s.
|
EXECUTED
AS A DEED POLL
|
| |
|
Signed,
Sealed and Delivered by me on
|
) |
|
|
the
__________ day of
____________ relevant year
|
) |
|
| at Melbourne |
) |
............................................................. |
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|
|
| Witnessed
by: |
............................................................. |
| Name of Witness: |
|
| Address of
Witness: |
Level 1, 1 Little Collins
st, Melbourne, VIC 3000 |
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