Get Online Selfexclusion Removal Request

Completing the online self-exclusion removal request is an important step for individuals seeking to reinstate their gaming privileges. This guide will provide clear and supportive instructions to ensure you effectively fill out the required form.

Follow the steps to successfully complete your removal request.

1. Press the ‘Get Form’ button to obtain the removal request form and open it in your browser.
2. Begin by reading the instructions carefully. Ensure you meet the eligibility criteria, including completing a minimum exclusion period.
3. Fill in your personal information in the designated fields: last name, first name, middle name, date of birth, height, and weight.
4. Provide your contact information, including home telephone number, daytime or work phone number, cell number (optional), and email address.
5. Enter your home address, including number and street, apartment number (if applicable), city, state, and zip code. If you have a different mailing address, fill that in as well.
6. Indicate if you have been known by any other names. If yes, include additional names and the dates during which you used them.
7. Sign the acknowledgment section, confirming that the information you provided is accurate and authorizing the Division of Gaming Enforcement to reinstate your gaming privileges.
8. Ensure you have proper identification ready to present upon submission, as identification containing your signature and a photo or physical description is required.
9. Submit the completed form electronically or schedule an appointment to submit in person, depending on your preference.

Take action today by completing your ONLINE SELFEXCLUSION REMOVAL REQUEST and regain your gaming privileges.