EXCLUSION SCHEME

Voluntary Self-Exclusion Request Form Vl l103/09

Macau Sporting Club

VOLUNTARY SEIF.EXCLUSION REQUEST FORM

To: The Manager, l6 Patrick’s Quay, Cork City, Ireland.

I wish to voluntarily self-exclude myself with immediate effect from all casinos operated by

Macau Sporting Club.

I recognise that this will result in me being nationally barred at ALL Macau Sporting Club

with immediate effect. I understand that I cannot enter any Macau Sporting Club Casino

whatsoever.

I understand and acknowledge the following:

I That, this voluntary self-exclusion agreement exists exclusively between myself and Macau

Sporting Club. I recognise that it my responsibility to inform any other casinos’ operators

of my wishes;

2 That, the period of self-exclusion is a minimum of 6 months (“Exclusion Period”) and that I

cannot retract, modify, revoke, withdraw or rescind my self-exclusion prior to the expiry of

the Exclusion Period;

3 That, I will receive written confirmation of my self-exclusion from Macau Sporting Club

I agree that Macau Sporting Club will not be held liable for any matter whatsoever if I enter

any of its premises during my period of self exclusion.

I release Macau Sporting Club, its officers and employees from any liability or claims in the

event that I fail to comply with this voluntary self-exclusion.

MEMBERSHIP NUMBER: ………………………….

NAME:   ……………………………………………..

ADDRESS: ………………………………………….

……………………………………………………………

……………………………………………………………

SIGNATURE: ………………………………………

DATE: ……………………………………

MANAGERS NAME………………… MANACERS SIGNATURE…………………………………..

Macau Sporting Club

(Registered office: Macau Sporting Club, 16 Patricks Quay, Cork City, Ireland)