Manpower List Form (MLF), ROASD-1039, Revision-0

Page No. Page 1 of 1 MANPOWER LIST FORM Form No. ROASD-1039 (MLF) Revision No. 0 Effectivity June 22, 2026 Use this form to notify PAGCOR regarding the existing Manpower of the entity. Please accomplish this form by providing correct and complete information. The entity shall submit this form to ROASD every 5th of the month, covering the personnel movements from the previous month. Name of Company: Business/Site Address: Email Address: Authorized Representative: Contact Number: CLASSIFICATION OF POSITION EMPLOYMENT TYPE OF VISA / BIRTHDAY SEX DATE HIRED (Managerial, SHIFT SCHEDULE FLOOR Number LAST NAME FIRST NAME MIDDLE NAME NATIONALITY REGISTRATION POSITION VISA NUMBER Passport No. (MM/DD/YYYY) (M/F) (MM/DD/YYYY) Supervisory, Non- (Ex. 6:00am to ASSIGNMENT LOCAL ADDRESS NUMBER (ERN) (FOR FOREIGN EMPLOYEES) 2:00pm) Supervisory, Non- Organic/Contractual) 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 27 28 29 30 INSTRUCTIONS: 1. All employees must be on the list (regular, contractual, probationary and under agencies). 2. All Filipino and foreign nationals should be properly documented. 3. Changes in format are not allowed. All fields should be properly filled out. 4. Dates must be encoded in month-day-year (Ex. April 30, 2026). 5. List should be submitted strictly monthly, every 5th of the month (pdf and excel file). 6. Accomplished MLF report should be signed and notarized upon submission. CERTIFICATION: This is to certify that the information provided herein has been carefully verified and found to be updated, accurate and complete. I understand that misdeclaration and incorrect information may lead to imposition of administrative penalties. Signature over Printed Name of Authorized Representative Date