The information you provide below supports this application as well as any future applications for revocation of your Self Exclusion.

Important information:

  • By completing this Request for Self Exclusion, you are electing to Self Exclude from all Crown Casinos, or both Crown and The Star Sydney Casino. This Request for Self Exclusion will be followed by the issuance of a Self Exclusion Order.
  • For Crown - You will be prohibited from entering or remaining in the Crown Sydney VIP Casino operated by Crown Sydney Gaming Pty Ltd (‘Crown Sydney’), the casino operated by Crown Melbourne Limited (‘Crown Melbourne’) and the casino operated by Burswood Nominees Limited (‘Crown Perth’) (each a ‘Crown Casino’).
  • If you elect to Self Exclude from both Crown and The Star Sydney Casino Casinos, you must upload the NSW Casinos Self Exclusion Form, duly witnessed by an authorised person.
  • Crown is required by law to inform The Star Sydney Casino of your exclusion, even if you only elect to Self Exclude from Crown Casinos. Star may act to exclude you.


I wish to make this Self Exclusion (application). In making this application, I acknowledge and agree to the following*

Part 1 of 5 – Required documents upload

What is your home property?*
What type of Self Exclusion are you choosing? *

Part 2 of 5 – Personal information

Part 3 of 5 – Your playing profile

5. Do you understand that you are prohibited from making any wager in the Crown Sydney VIP Casino under section 86A of the Act, and that any winnings paid or payable to you will be forfeited to Crown Sydney under section 86A(2) of the NSW Casino Control 1992 Act, and paid into the Responsible Gambling Fund?

Part 4 of 5 – About your exclusion

6. Have you previously excluded yourself from any other Gaming Operators?*
14. You will be issued with an Exclusion Order which prohibits you from entering and remaining in the Casino at Crown Sydney pursuant to section 79(3) of the Casino Control Act 1992 (NSW) and in Crown Melbourne pursuant to section 72 of the Casino Control Act 1991 (VIC) and Crown Perth under section 26(2) of the Casino Control Act 1984 (WA).

Part 5 of 5 – Your exclusion process

15. What is your communication preference for the application outcome - SMS, Email, Both (Self Exclusion orders will be sent via registered mail to the address provided)*
16. Would you like a follow up call three months after you receive the Self Exclusion Order from one of our external support agencies?*
17. Please select your minimum Self Exclusion period (this is the period during which you cannot apply to revoke your Self Exclusion) *
18. Do you understand that you cannot apply for a revocation until after the selected minimum exclusion period has passed from the date the Exclusion Order is issued to you and that Crown may apply conditions on a revocation? Do you also understand that Crown will not generally revoke a voluntary Exclusion Order (Self Exclusion) within 12 months of the date of any breach of the Exclusion Order? To apply for a Revocation, you will need to make an application and complete the relevant requirements for your return.
As this form is a legally binding voluntary application, please make sure that you have entered all the information correctly before submitting.
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