Self – Exclusion

Lottery Self-Exclusion Form

Gambling Commission – Licence Conditions and Code of Practice

If you feel you have a problem with gambling and would like to request that St Catherine’s Hospice exclude you from all of its gambling related activities, including receiving gambling related marketing materials, you can simply complete and submit the form below.

I acknowledge that I will not be allowed to rescind my self-exclusion during this period.

Following our successful completion of your self-exclusion request:

– Your chosen self-exclusion period will remain in force with St Catherine’s Hospice, for your selected minimum period.
– St Catherine’s Hospice will not send you any gambling related marketing materials, unless and until you specifically request us to do so.

Please ring the St Catherine’s Hospice Lottery Team on 01293 447373, if you wish to extend your chosen self-exclusion period (minimum 6 months extension).

Please note, for those members playing by standing order or direct debit, that in addition to completely this form it will be necessary for you to cancel your regular payments with your bank. Any credits currently held against your lottery membership(s) will be returned to you approximately 15 working days after receipt of this form.

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St Catherine’s Hospice Limited is licensed and regulated in Great Britain by the Gambling Commission under account number 4880

BeGambleAware provides confidential counselling, advice and information to those affected by a gambling problem. If you feel you have a problem with gambling, call the National Helpline on 0808 8020 133, or visit
Remember that it is an offence for any persons under the age of 16 years to participate in a lottery.