Request to self-exclude

Complete the form below, alternatively call the Lottery Office on (0116) 231 8430 or write to the Lottery Manager at LOROS Lotteries Limited, LOROS, Groby Road, Leicester LE3 9QE.

SELF EXCLUDE

Gambling self-exclusion form

By completing and submitting the below form, I request that I be excluded from gambling with LOROS for a period of 6 months. I acknowledge that I am not allowed to rescind my self-exclusion during this period. I acknowledge my responsibility in ensuring adherence to this agreement. I release LOROS, its employees and agents from any liability or claims in the event that I fail to comply with this voluntary exclusion.

LOROS, Groby Road, Leicester LE3 9QE