In the Alter Rebbe's siddur Alex linked to in a comment here, A similar idea, called "Seder Nezifa" (Order of Condemnation) is performed. It's is found in the Siddur of the Shelah and Arizal (see here for sources). In it, the person accepts condemnation upon himself, and then asks the Beis Din to remove the condemnation, which they do.
The Mateh Efraim, Avodat Hakodesh, and the Sha'arei Teshuva are quoted as saying (see here for sources) that many people don't do this now days, since we don't know if the people we are asking to release us from excommunication are fit to do it. The Avodat Hakodesh also quotes a Zohar that says someone who was condemned his prayers do not ascend to Heaven for 40 days.
Minhag Chabad is not to say the Seder Nezifah (see footnote 17 here).
All that being said, the nusach quoted in the question does not have the person accepting condemnation upon himself. Instead he is asking to be released from excommunication, should he need it. Perhaps that is different, although it would seem that the worry of the Mateh Efraim and the Avodat Hakodesh would still apply.