Application/renewal for permit to exhibit gaming equipment and gaming paraphernalia (For Gaming Showroom)

APPLICATION/RENEWAL FOR PERMIT TO EXHIBIT Page No. Page 1 of 3 GAMING EQUIPMENT AND GAMING Form No. GLDD - 1561 PARAPHERNALIA Revision No. 2 (FOR GAMING SHOWROOM) Effectivity February 19, 2024 1. Only Enrolled Suppliers with Gaming Showroom shall be eligible to apply for a Permit to Demo Gaming Equipment and Gaming Paraphernalia. 2. An application for the Permit to Demo Gaming Equipment and Gaming Paraphernalia shall be site specific. B. DIRECTION FOR ACCOMPLISHMENT OF THE APPLICATION 1. TYPE or PRINT your answers on the application form. 2. State N/A in response to a question that does not apply to you or if there are no details to disclose in a response to a particular question. 3. Attached additional sheet/s if the space provided on the form is insufficient for your answer. All the pages of the application form, including t h e additional sheet/s (if any) must be signed by the applicant or its authorized representative providing the information. C. AUTHORIZED REPRESENTATIVE 1. The Applicant must designate an authorized representative responsible for the completion of the application form and certification of all information provided. 2. A b o a r d resolution or secretary's certificate must be attached to this application to substantiate the designation of the authorized representative. D. ATTACHMENTS TO THE RENEWAL APPLICATION 1. Duly accomplished FORM No. 1012 – Specimen Signature Card 2. Registration Certificate issued by any of the following agencies: (if applicable) a. Department of Trade and Industry (DTI); or b. Securities and Exchange Commission (SEC) 3. Articles of Partnership/Corporation and By Laws (if applicable) Note: Foreign suppliers may substitute items no. 2 and 3 with equivalent document/s issued by their respective countries provided that these documents are duly acknowledged and authenticated by the Philippine Embassy or Consular office therein if translated in English. 4. Certified True Copy of Income Tax Return (ITR) for the previous year. (if applicable) E. SUBMISSION OF APPLICATION Submit this form together with the required attachments to: Philippine Amusement and Gaming Corporation (PAGCOR) Gaming Licensing and Development Department (GLDD) MET Live Building, Central Business Park 1-A Macapagal Boulevard cor. EDSA Extension, Pasay City 1300 For inquiries you may reach us at: Tel No: ( + 6 3 2 ) 8 5 2 2 - 0 2 9 9 / 8 5 2 2 - 1357/8522-1245/8522-1324, local 1600 Email address: [email protected] Hours available: 8:00 AM - 7:00 PM

APPLICATION/RENEWAL FOR PERMIT TO EXHIBIT Page No. Page 2 of 3 GAMING EQUIPMENT AND GAMING Form No. GLDD - 1561 PARAPHERNALIA Revision No. 2 (FOR GAMING SHOWROOM) Effectivity February 19, 2024 NEW RENEWAL STRICTLY CONFIDENTIAL PART A: BASIC INFORMATION 1. Name of Supplier: 2. Head Office / Business Address: 3. Local Business Address (if any): 4. Tel. No.: 5. Fax No.: 6. Email Address: 7. Company Website: PART B. AUTHORIZED REPRESENTATIVE 8. Name: 9. Position or Title in the Company (e.g., board of director/secretary etc) 10. Tel. No. 11. Fax No. 12. Mobile No. 13. Email Address Authorized Representative Signature:

APPLICATION/RENEWAL FOR PERMIT TO EXHIBIT Page No. Page 3 of 3 GAMING EQUIPMENT AND GAMING Form No. GLDD - 1561 PARAPHERNALIA Revision No. 2 (FOR GAMING SHOWROOM) Effectivity February 19, 2024 PART C. APPROVED GAMING EQUIPMENT AND PARAPHERNALIA FOR EXHIBIT/DEMO 14. Item/s to be stored Gaming Table Bingo machine or console Playing Cards Chips/Plaques Slot Machine Spare Parts/Accessories Game Conversion Kits Slot Machine Signage Gaming Table Layout Casino Management System for Tables, Slots or E-Bingo Surveillance Equipment Bingo Flashboard Gaming Paraphernalia Bingo Paraphernalia Slot Machine Bingo Tickets Bingo Balls Electronic Table Games/Terminals Others (Pls. Specify) Electronic Bingo Machine/Terminals PART D. GAMING SHOWROOM DETAILS 15. Storage Facility Name 16. Storage Facility Address 17. Storage Facility Ownership Owned Leased If LEASED, please provide the following details 18. Name of Lessor 19. Lease Period PART E. ACTION TAKEN (to be filled up by GLDD) 20. ANNUAL INVENTORY OF GAMING EQUIPMENT AND GAMING PARAPHERNALIA (Please attached Inventory Report) Date Submitted: Remarks: PART F. DECLARATION I hereby declare that all information contained herein including all documents submitted are true and correct. Authorized Representative Signature :