Local Avatar Clearance Request and Approval Form

Page No. Page 1 of 2 LOCAL AVATAR CLEARANCE REQUEST Form No. GLDD –1449 AND APPROVAL FORM Revision No. 2 Effectivity July 6, 2022 Use this form to request clearance from PAGCOR for local Avatar for junket groups at the casino. Only requests with correct and complete information and complete documentary requirements will be processed. Failure to provide correct and complete information could result in rejection of processing this request. One (1) application form per junket group policy will be implemented. PLEASE ALLOW SEVEN (7) DAYS FOR GLDD TO PROCESS YOUR REQUEST Licensee : Casino Location : Date : SECTION A: DETAILS OF PROPOSED LOCAL AVATAR(S) (TO BE PROVIDED BY LICENSEE) This is to request for approval to allow the following local avatar(s) for the following junket group: New application Renewal Name of Junket Group : Name(s) of Local Avatar(s) : DOCUMENTS FOR SUBMISSION  Certified true copy of valid NBI Clearance Certificate  Employment Identification Card issued by the Junket Operator This is to certify that the above document/s for the proposed local avatar(s) is/are authentic. Name of Requestor : Signature : Position Title : Date: SECTION B: SUBMISSION INSTRUCTION Once Section A is completed, please submit this form to GLDD along with the necessary attachments. Hard copies may be submitted directly to the GLDD office or scanned copies may be emailed using the e-mail address of the concerned licensed casino indicated below: Gaming Licensing and Development Department Philippine Amusement and Gaming Corporation 12th Floor, iMET BPO Tower, CBP-1A Metropolitan Park, Roxas Blvd, Pasay City Tel. No. (02) 755-3199 / 755-3299 / 755-3999 E-mail addresses: [email protected] / [email protected] [email protected] / [email protected] [email protected] / [email protected] [email protected] / [email protected] [email protected] / [email protected] [email protected]

Page No. Page 2 of 2 LOCAL AVATAR CLEARANCE REQUEST Form No. GLDD –1449 AND APPROVAL FORM Revision No. 2 Effectivity July 6, 2022 SECTION C: ACTION TAKEN (TO BE FILLED UP BY GLDD) A. RETURNED due to the following reasons: Illegible/unreadable submitted documents Incomplete documentary requirements B. RECEIVED FOR PROCESSING with assigned Reference No. ________________ By: Printed Name: ______________________________ Signature: ________________________ Position Title: ______________________________ Date: ________________________ C. RECOMMENDATION FOR APPROVAL subject to the following: 1. Local Avatar Clearance shall be valid from _____________, 20___ until the travel ban of foreigners inbound Philippines is lifted by the Bureau of Immigration (“BI”) and/or Inter-Agency Task Force for the Management of Emerging Infectious Diseases (“IATF”). 2. The Licensee shall issue IDs for the proper identification of these local avatars. 3. Please see the REMARKS below for additional conditions. By: Printed Name: ______________________________ Signature: ________________________ Position Title: ______________________________ Date: ________________________ Verified by: Approved by: Acting Senior Manager, CLRD, GLDD Assistant Vice President, GLDD REMARKS