Self Exclusion
Passport Size
First Name   *
Middle Name
Last Name   *
Gender   *
Mobile Number   *
Attach ID
Self Exclusion Reason   *
Physical Address
Region   *
District   *
Street/Block   *
P.O Box

I Here by Want to Exclude myself from Gambling and All Gambling Activity, Please I Humbly Request Gaming Board of Tanzania to Make sure they Post my Pictures and ID in Every Gambling area, Thanks in Advance