Gaming Code of Practice Breach Allegation Form

If you have any queries in relation to this form, please contact gamingcode@clubsnsw.com.au.

Date of Incident

Club

First Name

Last Name

Address

Email Address

Phone number

Section(s) of the Code Allegedly Breached

Details of the Alleged Breach

Attach copies of all Relevant Documents Such as Correspondence from the Club Here:

Have you attempted to resolve the matter directly with the Club? What was the result of efforts to resolve the matter directly with the Club?

Attach copies of correspondence to the club and the club’s response here:

What outcome are you seeking in this matter?

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