Application for Renewal of Permit to Possess Gaming Equipment and Gaming Paraphernalia

Page No. Page 1 of 4 APPLICATION FOR RENEWAL OF PERMIT Form No. GLDD - 1011 TO POSSESS GAMING EQUIPMENT AND Revision No. 1 GAMING PARAPHERNALIA Effectivity September 1, 2019 A. DEFINITION OF TERMS “approved gaming equipment” means gaming equipment of a class approved by PAGCOR for use in a gaming establishment. “Enrolled Supplier” means a person or entity to which a Certificate of Enrollment has been granted for the purposes of acting as a supplier in the Philippines. “gaming paraphernalia” means apparatus, furnishing or accessories used in or necessary in the conduct of gaming operations. “gaming establishments” shall refer to venues in the territorial jurisdiction of the Republic of the Philippines that are operated and regulated by PAGCOR. “GLDD” means the Gaming Licensing and Development Department of PAGCOR. “Operator” means a Person who is authorized to operate a gaming establishment in the territorial jurisdiction of the Republic of the Philippines. An Operator may be PAGCOR, a Licensee or a Grantee. “PAGCOR” means the Philippine Amusement and Gaming Corporation or its successor entity, whereby “successor entity” means any successor or assignee to or replacement of PAGCOR in its capacity as a Person entitled to, among others (i) regulate and license all gaming establishments; and (ii) register and affiliate suppliers of approved gaming equipment and paraphernalia in the territorial jurisdiction of the Republic of the Philippines “SRM” means the Supplier’s Regulatory Manual that shall govern the suppliers plying their business in the Philippine jurisdiction “supplier” means a person that provides goods and services. “storage facility” means a building, area, space or room that is owned or leased by the Supplier for the sole purpose of storing approved gaming equipment and gaming paraphernalia.

Page No. Page 4 2 of 4 APPLICATION FOR RENEWAL OF PERMIT Form No. GLDD - 1011 TO POSSESS GAMING EQUIPMENT AND Revision No. 1 GAMING PARAPHERNALIA Effectivity September 1, 2019 B. RENEWAL OF PERMIT TO HOLD GAMING EQUIPMENT AND GAMING PARAPHERNALIA 1. The Permit to Hold Gaming Equipment and Gaming Paraphernalia has a validity of one (1) year and is renewable for another year covering specific items and quantity. 2. The renewal of the Permit to Hold Gaming Equipment and Gaming Paraphernalia shall be site specific. C. 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 the additional sheet/s (if any) must be signed by the applicant or its authorized representative providing the information. D. 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 board resolution or secretary's certificate must be attached to this application to substantiate the designation of the authorized representative. E. ATTACHMENTS TO THE RENEWAL APPLICATION 1. Duly accomplished SRM Form No. 4 – Specimen Signature Card 2. Copy of the expiring Permit to Hold Gaming Equipment and Gaming Paraphernalia 3. Updated 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) 4. Updated copy of 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. 5. Copy of Income Tax Return (ITR) for the previous year. 6. Proof of Accreditation from an Operator F. SUBMISSION OF APPLICATION Submit this form together with the required attachments to: Philippine Amusement and Gaming Corporation (PAGCOR) Gaming Licensing and Development Department (GLDD) th 12 Floor iMET BPO Tower CBP-1A Metropolitan Park Roxas Blvd., Pasay City For inquiries you may reach us at: Tel No: (02) 5221242 to 45 loc 5006 Email address: [email protected] Hours available: 8:00 AM - 7:00 PM

Page No. Page 3 of 4 APPLICATION FOR RENEWAL OF PERMIT Form No. GLDD - 1011 TO POSSESS GAMING EQUIPMENT AND Revision No. 1 GAMING PARAPHERNALIA Effectivity September 1, 2019 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:

Page No. Page 4 of 4 APPLICATION FOR RENEWAL OF PERMIT Form No. GLDD - 1011 TO POSSESS GAMING EQUIPMENT AND Revision No. 1 GAMING PARAPHERNALIA Effectivity September 1, 2019 PART C. APPROVED GAMING EQUIPMENT AND PAPARPHERNALIA FOR STORAGE 14. ITEMS TO BE STORED Gaming Table(s) Bingo machine or console Playing Cards(s) Chips/Plaques Slot Spare Part(s) Game Conversion Kit(s) Table Layout(s) Slot Machine Signage(s) Surveillance Equipment Casino Management System for Tables, Slots or Ebingo Gaming Paraphernalia Bingo Flashboard Bill Validator/Acceptor Bingo Cards/Tickets Slot Machine(s) Bingo Balls Electronic Table Game(s) Bingo Paraphernalia (Pls. Specify) E-bingo Machine/Terminal Others (Pls. Specify) PART D. STORAGE FACILITY 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: