APPLICATION FOR EXCLUSION
	Downloadable forms:
	1.  Self Exclusion Application Form
	2.  Family Exclusion Application Form
	3.  Licensee-Emanating Exclusion Form
	4.  Online User Access Control Form (NDRP)
	5.  Endorsement for Electronic Submission of Personal Disclosure Statement (PDS)
	6.  On-line User Access Control Form (PDS)
	7.  Petition to Amend the Exclusion Period
	8.  Notice to Show Cause
	9.  Notice of Imposition of Penalty
	10.  Notice of Non-Compliance (RG)

PROCEDURE

PAGCOR provides patrons who feel that relatives or they themselves are developing a problem with gaming with the option of barring them from the gaming venue or site.

PAGCOR and the gaming establishments shall not disclose information gathered during the facilitation of an application for Exclusion to any third party, unless legally obliged to do so or with the player’s consent.

1. Player Exclusion Types



(a) Self Exclusion

• (i) Exclusion forms may also be made available at PAGCOR operated and regulated gaming site.


• (ii) Applicant must submit the following documents:
• Photocopy of one (1) valid government ID card with photo
• Fully accomplished RG Form 2
• One (1) 2x2 photo taken within 6 months from application date


• (iii) Applicant may request for an exclusion period of 6 months, 1 year or 5 years. After completion of the exclusion period, the self-exclusion order will be lifted automatically. A self-exclusion period for the first six (6) months is irrevocable.


• (iv) An extension of self-exclusion may be requested for at least six (6) months. RG Form 2 shall be accomplished and submitted again.


• (v) Regardless of where application was applied, the self-exclusion order shall be enforced in all PAGCOR operated and regulated gaming facilities. Names of excluded persons shall be posted in PAGCOR’s national database of Restricted Personalities.



(b) Family Exclusion

• (i) Exclusion forms may also be made available at PAGCOR operated and regulated gaming site.


• (ii) The family member is considered the applicant while the problem gambler is the respondent.


• (iii) Any one of the following family members may request for a player’s exclusion:
• spouse
• child at least 18 years old
• parent


• (iv) Immediate family member applying for exclusion must submit the following documents:



If applicant is the parent:

• Photocopy of valid government ID with photo of respondent
• Photocopy of Birth Certificate of respondent
• Photocopy of valid government ID with photo of applicant
• One (1) 2x2 photo of respondent taken within 6 months from application date
• Fully accomplished RG Form 3




If applicant is the child:

• Photocopy of valid government ID with photo of respondent
• Photocopy of Birth Certificate of applicant
• Photocopy of valid government ID or school ID with photo of applicant
• One (1) 2x2 photo of respondent taken within 6 months from application date
• Fully accomplished RG Form 3




If applicant is the spouse:

• Photocopy of valid government ID with photo of respondent
• Photocopy of Marriage Contract
• Photocopy of valid government ID with photo of applicant
• One (1) 2x2 photo of respondent taken within 6 months from application date
• Fully accomplished RG Form 3



In lieu of the Birth Certificate, a foreign applicant may submit an official document issued by its government establishing his/her identity as well as the respondent’s and their relationship, the authenticity of which must be certified by the Department of Foreign Affairs of the Philippines

Incomplete requirements shall not be processed.

• (v) The exclusion order shall take effect and shall be enforced irrevocably.


• (vi) Upon expiration of the exclusion, the relative may re-apply (RG Form 3), otherwise, the Family Exclusion Order shall be lifted automatically.


• (vii) Regardless of where application was applied, the Family Exclusion Order shall take effect in all PAGCOR operated and regulated gaming facilities. Names of excluded persons shall be posted in the national database of Restricted Personalities.


2. Submission of Application

Complete documentary requirements listed under #1 with a fully accomplished and signed application form and submit inside a sealed long-sized brown envelope with the following text written on it:

APPLICATION FOR EXCLUSION ORDER
Gaming Licensing and Development Department

11th Floor | Contact No.: +632 8521-1542 / +632 8522-0299 loc 1166
PAGCOR CORPORATE OFFICE
MET LIVE BUILDING
Central Business Park 1-A
Macapagal Boulevard cor. EDSA Extension
Pasay City 1300, Metro Manila

Send the envelope to the above address either through:

• (a) personal delivery, drop the envelopes inside the designated box located at the lobby of PAGCOR House or


• (b) courier service