Destruction of Gaming Equipment and other Gaming Paraphernalia Request and Approval Form, ROASD-333, Revision-3

Page No. Page 1 of 2 DESTRUCTION OF GAMING EQUIPMENT Form No. ROASD-333 AND OTHER GAMING PARAPHERNALIA REQUEST AND APPROVAL FORM Revision No. 3 Effectivity August 4, 2026 Use this form to notify PAGCOR regarding destruction of gaming equipment and other gaming paraphernalia. Please accomplish this form by providing correct and complete information. The Data Streaming Provider shall submit this form to ROASD at least three (3) business days prior to intended date of implementation. Data Streaming Provider : Operating Address : Date : Date of Implementation : SECTION A: PROPOSED DESTRUCTION OF DISCONTINUED GAMING EQUIPMENT AND OTHER GAMING PARAPHERNALIA (TO BE PROVIDED BY DSP) Please be informed of the destruction of the following gaming equipment and other gaming paraphernalia: ITEM MODEL/ DESCRIPTION Reason for Mode of Destruction QUANTITY NO. PAGCOR TAG Destruction 1 2 3 4 5 6 7 8 9 10 (Note: Please use additional sheet/s if the space provided above is not sufficient) We confirm and undertake to do the following: ▪ Destruction of gaming equipment and other gaming paraphernalia are compliant with applicable laws pertaining to disposal and destruction of equipment. ▪ Members of the PAGCOR Monitoring Team (PMT) as well as representatives from the DSP shall witness the destruction procedure. The DSP and PMT shall ensure that all gaming equipment and other gaming paraphernalia are completely destroyed and rendered unusable for gaming operations. Printed Name : Signature : Position Title : Date:

Page No. Page 2 of 2 DESTRUCTION OF GAMING EQUIPMENT Form No. ROASD-333 AND OTHER GAMING PARAPHERNALIA REQUEST AND APPROVAL FORM Revision No. 3 Effectivity August 4, 2026 SECTION B: SUBMISSION INSTRUCTIONS Once Section A is completed, please submit this form to ROASD together with supporting documents. Hard copies may be submitted directly to the ROASD office indicated below: Remote Operations and Ancillary Services Department 11th Floor, MET Live Building, Central Business Park 1-A, Macapagal Boulevard cor. EDSA Extension, Pasay City 1300 Trunk Line: (+632) 8522-0299 local 1195 SECTION C: ACTION TAKEN (TO BE FILLED UP BY ROASD) A. RETURNED due to the following reasons: Incomplete information and/or supporting ship-out documents Incorrect information vis-à-vis supporting ship-out documents B. RECEIVED FOR PROCESSING with assigned Reference No. By: Printed Name: Signature: Position Title: Date: C. RECOMMENDATION FOR APPROVAL subject to the conduct of inspection and inventory by the Compliance Monitoring and Enforcement Department prior to ship-out of gaming equipment indicated above. By: Printed Name: Signature: Position Title: Date: Approved by: Assistant Vice President, ROASD