Gambling Harm Service Referral Form

7 March 2019

In September last year The Salvation Army Oasis along with the Ministry of Health launched the Multi Venue (MVE) National Administration Service (NSA). The aim of the newly launched service was to streamline and facilitate the Multi Venue Exclusion requests (MVE Requests).

Clubs New Zealand recently met with the team from the MVE National Administration Service to discuss how things are going and what the future might look like. Part of our discussion also involved how clubs can better support members or guests who have excluded from the venue by utilising referrals.

Quick overview of the MVE Process (simplified):

Service Provider Facilitated MVE:

  1. An individual will work with the Service Provider/Councillor to assess the suitability of exclusion for the individual. 
  2. The provider will assist the individual to complete a Provider Initiated Self-Exclusion MVE and this will be emailed to the National MVE Administer with the request and appropriate information. 
  3. Once the MVE Administrator has received the request they will email/post the cover letter including the photo and copy of the MVE request form to appropriate venue(s).
  4. On receiving an MVE request from the MVE Administration, the venue manager issues an Exclusion Order (use the ClubSmart Exclusion Orders found in your completed gaming forms folder) and posts/emails the clients copy promptly to the National MVE Administrator and a copy is retained at your venue.  In this case the venue is not required to send a copy directly to the excluded person, the MVE Administration will do this for you.

Venue Facilitated Exclusion under s310 or s309:

  1. This is the exclusion order process you all know, you have identified through monitoring that a person should be issued an exclusion order (venue initiated) or a person has requested to be excluded from your venue (self exclusion).  The venue manager will complete the exclusion order, with a copy provided to the individual, a copy is held on record at the club and a copy is sent to Clubs New Zealand.

See the full Multi Venue Exclusion Process Overview here

In the case of venue facilitated exclusions under s310 or s309 many clubs have been asking what they can be doing above and beyond issuing an exclusion order. Many clubs want to further assist their members and guests as part of their culture of care and that is where the referral process comes into play.

In order to refer an excluded person to the MVE Administration Service you need to seek their permission in the form of a referral request. Clubs New Zealand has worked with the MVE Administration team to produce the Clubs New Zealand Gambling Harm Service Referral Form which you can download below;

Gambling Harm Service Referral Form

We recommend that you print off a number of copies of the form and store them in your Clubs New Zealand Gaming Compliance Folder with the Letters to Gambler or Blank Exclusion Orders Section.

When issuing a venue initiated or self exclusion you will also request that the individual completes the Gambling Harm Service Referral Form.  The completed gambling harm service referral forms should be scanned and emailed to;

The National Administration Service
The Salvation Army Oasis

Upon receiving the referral the MVE administration will contact the person to provide assistance with extending the exclusion (issued at your venue) to other gambling venues (MVE), provide relevant confidential support as well as referral to other services if and when required.

For more information on the MVE process please contact or get in touch with the MVE Administration Service (they are always ready to help).


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