PAGCOR Issuances
Compliance Authorized Representative (Form C)
Page No. Page 1 of 1 COMPLIANCE AUTHORIZED REPRESENTATIVE Form No. OGLD - 1176 (Form C) Rev. No. 5 Effectivity March 04, 2025 Name of Company: Business Address: Contact Number: DETAILS AUTHORIZED PERSONNEL ALTERNATE AUTHORIZED PERSONNEL NAME: POSITION TITLE: E-MAIL ADDRESS: OFFICE NUMBER: MOBILE NUMBER: SPECIMEN SIGNATURES: 1. 1. 2. 2. 3. 3. *Please attach copies of valid government-issued IDs.
Page No. Page 2 of 1 COMPLIANCE AUTHORIZED REPRESENTATIVE Form No. OGLD - 1176 (Form C) Rev. No. 5 Effectivity March 04, 2025
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