Cmed Ir 471 Jackpot Verification

Page No. Page 1 of 1 Form No. CMED IR- 471 JACKPOT VERIFICATION Revision No. 1 Effectivity July 12, 2023 LICENSEE: DATE: CLUSTER: TIME: A. MACHINE TYPE : Jackpot Stand-alone Progressive Progressive/Bonus Jackpot B. MACHINE DETAILS LOCATION : LINK NAME : SERIAL NUMBER : AMOUNT (PHP) HIT : ASSET NO. / MACHINE ID : GAME OUTCOME : MANUFACTURER : HANDPAY SLIP NUMBER : GAME THEME : OTHER INFORMATION : GAME VERSION : DENOMINATION : RTP % : CURRENT SEAL NUMBER : C. VERIFICATION PROCEDURE (CHECKING OF THE ACTUAL MACHINE STATUS DURING JACKPOT) (Please check the box "Yes", "No" or "NA" for the actual machine status). Yes No NA 1. The winning machine door is locked. Yes No NA 2. The winning machine has no signs of tampering. Yes No NA 3. The winning machine has no error or faulty message displayed on the gaming machine or progressive display. Yes No NA 4. Shows the correct winning amount on the winning game machine or progressive display. Yes No NA 5. Noticeable indicator such as "visible" e.g. glowing light (LED) or "audible" message of the winning machine. Yes No NA 6. Fullfilled the prescribed jackpot game rule, condition and features. REMARKS: PREPARED BY: VERIFIED BY: VERIFIED BY: DESIGNATION FULLNAME ID OVER SIGNATURE DESIGNATION FULLNAME ID OVER SIGNATURE DESIGNATION FULLNAME ID OVER SIGNATURE LICENSEE REPRESENTATIVE LICENSEE REPRESENTATIVE LICENSEE REPRESENTATIVE Date : Date : Date : NOTED BY: WITNESSED BY: RECEIVED BY (FOR PMT COPY): DESIGNATION FULLNAME ID OVER SIGNATURE DESIGNATION FULLNAME ID OVER SIGNATURE DESIGNATION FULLNAME ID OVER SIGNATURE LICENSEE REPRESENTATIVE LICENSEE REPRESENTATIVE PAGCOR MONITORING TEAM REPRESENTATIVE Date : Date : Date Received :