Self Exclusion Program
Suffolk Regional Off Track Betting Corporation Voluntary Self Exclusion Program

The Suffolk Regional Off Track Betting Corporation's voluntary self exclusion program is a New York State mandated program to assist compulsive gamblers. The purpose of the program is to allow compulsive gamblers the opportunity to request that they be excluded from entering and wagering in Suffolk Regional Off Track Betting Corporation branches. Those compulsive gamblers who wish to join the self exclusion program are required to complete an application. The application contains six parts, five to be completed by the applicant, one to be completed by Suffolk Regional Off Track Betting Corporation.

Applications are available at each of our branches and at Corporate Headquarters.

If any portion of the Application for self exclusion is not completed, the application will not be processed.

Upon approval of the application, the applicant will receive a receipt from Suffolk Regional Off Track Betting Corporation.

Any person may have himself or herself removed from the self exclusion program by completing the Suffolk Regional Off Track Betting Corporation Application for Removal from Self Exclusion List. These applications may be obtained from any of our branches or our Corporate Headquarters. No person shall be removed from the voluntary self exclusion program until seven (7) days after such application for removal is received by the Suffolk Regional Off Track Betting Corporation.

Completed applications may be returned to any Suffolk Regional Off Track Betting Corporation branch or Headquarters (425 Oser Ave., Suite 2, Hauppauge, NY 11788) in person or by mail.

Assistance for compulsive gamblers is available by the National Council on Problem Gambling at 1-800-522-4700.

Instructions for completing Application for Self Exclusion

Part 1 -Identifying Information
This portion of the application contains basic information: Name, Aliases (any other names or nicknames the applicant might be known by), physical description (height in feet and inches; weight in pounds; hair color; eye color; and at the applicants option skin color); any other noticeable physical characteristics; home address; social security number; and D.O.B. (date of birth - month, day, year)

Part 2 - Statement of Self Exclusion
Applicant must enter their printed name and then sign this statement.

Part 3 - Photograph
Each application must be accompanied by a photograph (or photocopy of a photograph) such as a driver's license or passport. The photograph must be such that the applicant can be recognized.

Part 4 - Affidavit
Each application must contain this part which must be signed before a Notary Public.

Part 5 - Release
The applicant must print their name and then sign this release.


You can download the Application here:
Self Exclusion Application

Self Exclusion Removal Application