Application for Registration Training Facilities with Gaming Equipment Paraphernalia

Page No. Page 1 of 2 APPLICATION FOR REGISTRATION Form No. GLDD - 1023 TRAINING FACILITIES WITH GAMING Revision No. 3 EQUIPMENT AND PARAPHERNALIA Effectivity September 25, 2024 GENERAL INSTRUCTIONS 1. Please type or print legibly. Use black pen/ink only. 2. A complete application includes:  Duly Accomplished Application Form  Certified Board resolution on the facility as a venue for gaming and casino-related skills training programs;  Names and Positions of officials who will supervise the operations of the training facility  Certified inventory of the gaming equipment and paraphernalia and their serial/reference numbers (classified according to location/training venue)  Copy of the training facility floor plan with CCTV layout 3. All submitted documents must be compiled in a folder with proper indexes and labeling. 4. Application with incomplete requirements shall not be accepted. COMPLETE NAME OF APPLICANT/COMPANY

Page No. Page 2 of 2 APPLICATION FOR REGISTRATION Form No. GLDD - 1023 TRAINING FACILITIES WITH GAMING Revision No. 3 EQUIPMENT AND PARAPHERNALIA Effectivity September 25, 2024 GENERAL INFORMATION NAME OF COMPANY/LICENSED COMPLETE ADDRESS TELEPHONE NUMBER FAX NUMBER E-MAIL ADDRESS NAME OF COMPANY HEAD POSITION/DESIGNATION LIST OF OTHER VENUES/ADDRESSES AT WHICH TRAINING SHALL BE CONDUCTED Venue/Address 1 Venue/Address 2 Venue/Address 3 Venue/Address 4 NUMBER OF APPROVED GAMING TABLES NUMBER OF APPROVED SLOT MACHINE UNITS (EGM and SM) IS TRAINING PROVIDED BY A 3rd PARTY? IF YES, CHECK THE BUSINESS RELATIONSHIP OF THE TRAINING PROVIDER WITH THE LICENSED CASINO. YES NO PARENT COMPANY AFFILIATE COMPANY SUPPLIER COMPANY NAME OF THE TRAINING PROVIDER COMPLETE ADDRESS OF THE TRAINING PROVIDER TELEPHONE NUMBER FAX NUMBER E-MAIL ADDRESS NAME OF COMPANY HEAD POSITION DESIGNATION