Thank you for taking the time to submit your information. Hopefully, you'll find the form below self-explanatory and we look forward to hearing from you. If you need any support completing this form, please call us free on 0800 018 3310 or email retailaffordability@ladbrokes.com

• Please complete this form with the required information and upload any supporting documents

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Shop Details

Please enter the details of the shop in which information was requested

Your Details

Please enter your details

Questions

Thinking about your betting activity over the last twelve months, please answer the following questions:

Have you ever found yourself in financial difficulties through gambling more than you could afford to lose?
Have you ever borrowed money or gone into debt to obtain money for gambling?
Have you gambled money that was supposed to be spent on bills, rent or other commitments?

Your Earnings

Salary Band: Tick the band relevant to your annual income

Supporting Documents

Please upload your photo ID:

  • Photo Driving Licence (full/provisional) or

  • Passport

Drop files here
or