Gambling dispute form

Required fields are marked with an asterisk (*).

Your personal details

Are you making this report on behalf of someone else? *
Dispute must be lodged by the account holder in first instance. If lodging on behalf of other party or not the holder of an account, provide supporting material or an authority to act on their behalf.

Betting account details

Nature of complaint

For example, refusal to accept fixed odd bet, account closure, refusal to open account, restriction placed on account. Provide details.
Provide details of the contact made with the wagering operator, outcome of the enquiry, and include reasons given.
If you need to add documentation to outline the nature of your complaint, please upload below. Allowed extensions (.pdf, .docx, .doc, .xls, .xlsx). File size limit of 3MB.

Bet details

Include competitor(s), bet type, stake and price.
If 'other' is selected, please specify.
Dispute must be lodged within 14 days of the event. If outside of this period, an application for 'out of time' consideration must accompany this dispute.
Provide details of circumstances that warrant the acceptance of the dispute otherwise out of time. Provide attachment if applicable.
Allowed extensions (.pdf, .docx, .doc, .xls, .xlsx). File size limit of 3MB.

Attachments and other information

This includes all relevant correspondence, copies of betting slips, statement and the like which may assist in the investigation.
Allowed extensions (.pdf, .docx, .doc, .xls, .xlsx, .png, .jpg, .gif). File size limit of 5MB.
Is there other information that may help in our investigation? If yes, please provide details.
Please specify and attach a copy of one form of photo identification to this report. For example, drivers licence, passport, if other, please specify.
Allowed extensions (.pdf, .docx, .doc, .xls, .xlsx, .png, .jpg, .gif). File size limit of 5MB.
If yes, provide details. For example, Racing NSW - Bookmaker, Racing QLD - Trainer.
If yes, enter name of wagering operator and in what capacity.

Declaration, acknowledgements and agreements

Declaration statements

  • I indemnify and will keep indemnified NT Racing Commission against any loss arising out of, relating to or in connection with any information and documentation I provide to NT Racing Commission about my complaint that is untrue, incorrect, misleading or false.
  • An incomplete report may delay the investigation into my complaint and I may be asked to complete a new report and / or provide further information.
  • The information provided in this report or subsequently provided by me may be used to investigate or otherwise deal with my complaint and may be used in any subsequent Court proceedings relating to my complaint.
  • I may be called as a witness and required to give evidence under oath in any subsequent Court proceedings relating to my complaint.

Last updated: 19 October 2022

Give feedback about this page.

Share this page:

URL copied!