|
DEED OF SELF EXCLUSION
| THIS
DEED made on
Tuesday, November 30, 2004
by A. Citizen, |
| Date
Of Birth: 02-Oct-1960 of 555 Main Street, Melbourne, 3000 in |
| the
State of VICTORIA |
WHEREAS:
| 1. |
I believe
that I have a problem controlling my use of gaming machines at the
gaming venue at:
1) «insert
venue», «insert suburb»
2) «insert venue», «insert
suburb»
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 / Licensed Clubs Association
of Victoria (such Associations 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 at any
Tattersalls' venue in the Tatts Pokies Rewards program or the Tatts
Pokies Mailing program conducted across Victoria by certain Tatts
Pokies venues for the period of self exclusion. I authorise the Industry
Body to forward details of my Self Exclusion to Tattersalls Gaming
Pty Ltd ACN 081 925 680 (Tattersalls) to assist in the administration
of the Tatts Pokies Rewards program and the Tatts Pokies Mailing program.
|
| 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
01-December-2003[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 Counselor; and
|
| f) |
Not
seek to become a member of the Tatts Pokies Rewards program
or the Tatts Pokies Mailing program.
|
|
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 (including the use of reasonable
force) 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 (including
the use of reasonable force) 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 of the details of
my Self Exclusion, and I AUTHORISE Tattersalls to do all things necessary
to remove me from the Tatts Pokies Rewards program and the Tatts Pokies
Mailing 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, and the legal
personal representatives of any such persons (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 (including the use of reasonable force) 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
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 (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.
|
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
Tuesday, November 30, 2004
;
|
| 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;
|
| g) |
Tattersalls
will be advised of my undertakings contained in this Deed and
that Tattersalls shall be at liberty to forthwith remove me
from future participation in the Tatts Pokies Rewards program
and the Tatts Pokies Mailing program.
|
|
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 counseling from a qualified
Problem Gaming Counselor 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
Tuesday, November 30, 2004
|
) |
|
| at Melbourne |
) |
............................................................. |
|
|
|
| Witnessed
by: |
............................................................. |
| Name of Witness: |
Robert
Heveren |
| Address of
Witness: |
Level 1, 1 Little Collins
st, Melbourne, VIC 3000 |
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|
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| |
CERTIFICATION
OF REPRESENTOR
I,......................................................
of ................................................................
hereby certify that I have read and explained the contents of
this Deed to
.........................................................
on day of 2004 .
Signed: .............................................
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