1.16 SHIP-OUT CLEARANCE REQUEST AND APPROVAL FORM

Page No. Page 1 of 3 SHIP-OUT CLEARANCE REQUEST AND Form No. EGLD - 940 APPROVAL FORM Rev. No. 4 Effectivity January 08, 2024 GS Form No. 15 EGLD Reference No.:____________________ Use this form to request clearance from Electronic Gaming Licensing Department (EGLD) to ship-out equipment and/or paraphernalia from the PAGCOR-approved gaming venue. Only requests with correct and complete information and complete documentary requirements will be processed. Failure to provide correct and complete information could result in non-processing of this request. Cut-off for submission of requests shall be 4:00 P.M. ________________________________________________________________________________________________ PLEASE ALLOW FOURTEEN (14) BUSINESS DAYS FOR EGLD TO PROCESS YOUR REQUEST SECTION A: SHIP-OUT CLEARANCE REQUEST (TO BE PROVIDED BY OPERATOR) Name of Operator: _____________________________________________ GL No.: ____________________ (As reflected in the license) Gaming Venue Location: ______________________________________________________________________ (As reflected in the license) Game Offering: ______________________________________ Date of Implementation: _______________________________ This is to request approval to ship-out: (Put an [x] mark on any of the following) Electronic Gaming/Bingo Machine Auxiliary Table Game System Electronic Gaming/Bingo Machine Assembly Parts, Dice, Money Wheels, Pai Gow Tiles, Roulette Wheels, Peripherals, Accessories and Speakers Playing Card Shoes or Card Shufflers Progressive Jackpot System for Slots Games Progressive Jackpot System for Table Games Casino Management Systems for Slot Games Casino Management Systems for Table Games Gamer Conversion Kits Electronic Quickshot Bingo Units Gaming Chips/Plaques Electronic Daubers/Handsets Slot Machine Tokens Bingo Cards/Bingo Tickets Gaming Tables and Layouts Bingo Machine/Console or Electronic Flashboard Multi-deck Continuous Shufflers Rapid Bingo and Game Arts Terminal Electronic Sic Bo Tables / Dice Shakers Instant Bingo Games (Pull Tab/Break Open Games) Roulette Chipper Machines Instant Bingo Games (Scratch Games) Playing Cards Others: _____________________________________ Attachment: Inventory List of Items for Ship-out Description of subject item(s): Reason for ship-out: Pull-out location: Country of destination: Mode of ship-out: Port of exit: Name of recipient: Reference importation documents of items to be shipped-out: (Put an [x] mark on any of the following) Commercial Invoice No.: ___________________________ Other Invoice: ___________________________________ No.: __________________________ Custom Broker: ________________________________________ Telephone No.: ____________________

Page No. Page 2 of 3 SHIP-OUT CLEARANCE REQUEST AND Form No. EGLD - 940 APPROVAL FORM Rev. No. 4 Effectivity January 08, 2024 GS Form No. 15 EGLD Reference No.:____________________ SECTION B: SUBMISSION OF INSTRUCTIONS Once Section A is completed, please submit this form to EGLD along with the necessary attachments. Hard copies may be submitted directly to the EGLD office or scanned copies of the documents may be emailed using the e-mail addresses indicated below: Electronic Gaming Licensing Department Philippine Amusement and Gaming Corporation PAGCOR Main Corporate Office, 14th Floor, iMET BPO Tower, CBP-1A Metropolitan Park, Roxas Boulevard, Pasay City Tel. Nos.: 8522-0299 / 8522-1357 / 8522-1245 8522-1324 loc. 5301 / 5303 E-mail address: [email protected] SECTION C: ACTION TAKEN (TO BE FILLED UP BY EGLD) EGLD Reference No.: _________________ Ship-out clearance request is:  A. RECEIVED FOR PROCESSING By: Printed Name: _________________________________ Signature: _____________ Position Title: _________________________________ Date: ________________  B. RETURNED due to the following reasons:  Incomplete information and/or supporting ship-out documents  Incorrect information vis-à-vis supporting ship-out documents  C. RECOMMENDATION FOR APPROVAL By: Printed Name: ________________________________ Signature: ______________ Position Title: ________________________________ Date: __________________ Approved by: Assistant Vice President For endorsement to Compliance Monitoring and Enforcement Department (CMED): INSPECTION AND INVENTORY OF SUBJECT ITEM/S FOR SHIP-OUT T O: THE ASSISTANT VICE PRESIDENT, CMED Request to conduct an inspection and inventory by representative/s from CMED of the approved Subject Item/s prior to ship-out of subject item/s. REQUIRED DOCUMENT ATION OF SUBJECT ITEM/S FOR SHIP-OUT T O: THE ASSISTANT VICE PRESIDENT, LMD Request to coordinate with the Operator on the documentation that may be needed for the ship-out of the subject item/s.

Page No. Page 3 of 3 SHIP-OUT CLEARANCE REQUEST AND Form No. EGLD - 940 APPROVAL FORM Rev. No. 4 Effectivity January 08, 2024 GS Form No. 15 EGLD Reference No.:____________________ Attachment: INVENTORY LIST OF ITEMS FOR SHIP-OUT PARTICULARS (Game Name, Brand, PAGCOR NO. MANUFACTURER SERIAL NO. REMARKS Model) TAG NO. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. (Note: Please use additional sheet/s if the space provided above is not sufficient)