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State of New Jersey Division of Gaming EnforcementREQUEST FOR VOLUNTARY SELFEXCLUSION ATLANTIC CITY CASINO FACILITIES Including INTERNET GAMING ACTIVITIES; Internet GAMING OneNote: ONLY ONE REQUEST
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Here is how to fill out the self-exclusion form:
02
- Start by obtaining a copy of the form from the appropriate organization or gambling establishment.
03
- Read the instructions carefully before filling out the form.
04
- Provide your personal information accurately, including your full name, address, and contact details.
05
- Follow the specific guidelines provided for indicating the duration of the self-exclusion period.
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- Sign and date the form to make it legally binding.
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- Submit the completed form to the designated authority or responsible individual.
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- Keep a copy of the form for your records.
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- If necessary, seek guidance from support organizations or professionals.
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Who needs what is form self-exclusion?

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Anyone who wishes to voluntarily exclude themselves from participating in gambling activities may need a self-exclusion form.
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This form is typically required by individuals who recognize a gambling addiction or want to prevent themselves from engaging in problematic gambling behavior.
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Problem gamblers, individuals seeking to establish responsible gambling practices, or those looking for temporary abstinence may find the self-exclusion form beneficial.
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Form self-exclusion is a legal document that allows individuals to voluntarily remove themselves from participating in certain activities, usually related to gambling, to prevent addiction or harmful behavior.
Individuals who wish to limit or prohibit their access to gambling facilities or online gambling sites are required to file form self-exclusion.
To fill out form self-exclusion, individuals need to provide personal information such as name, address, date of birth, and a declaration of their intent to self-exclude from gambling activities.
The purpose of form self-exclusion is to provide individuals with a means to combat their gambling addiction by prohibiting themselves from participating in gambling activities.
The information that must be reported on form self-exclusion typically includes personal identification details, reasons for self-exclusion, and acknowledgment of the consequences of self-exclusion.
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