Destruction of Gaming Equipment and/or Paraphernalia Request and Approval Form

Page No. Page 1 of 2 DESTRUCTION OF GAMING EQUIPMENT AND/OR PARAPHERNALIA REQUEST AND Form No. GLDD-840 APPROVAL FORM Revision No. 2 (FOR SUPPLIERS ONLY) Effectivity Feb. 03, 2026 Use this form to request approval from PAGCOR regarding destruction of gaming equipment and/or gaming paraphernalia for GLDD-enrolled suppliers only. Please accomplish this form by providing correct and complete information. The Supplier shall submit this form to GLDD at least fourteen (14) business days prior to intended date of implementation. All requests for approval with incomplete information and/or attachment shall not be processed. PLEASE NOTE THAT PAGCOR RESERVES THE RIGHT TO CONDUCT POST-AUDIT ON THE GAMING EQUIPMENT AND/OR PARAPHERNALIA WHICH HAVE BEEN DESTROYED. Supplier: Date: Warehouse Address: Date of Implementation: GLDD Reference No.: Location of Destruction: Electronic Gaming Machines Electronic Bingo Machines and/or Component Parts Traditional Bingo Equipment and/or Component Parts and/or Paraphernalia Slot Machines Electronic Table Games SECTION A: PERMANENT DESTRUCTION OF GAMING EQUIPMENT AND/OR PARAPHERNALIA (TO BE FILLED UP BY THE SUPPLIER) I. A. DETAILS OF GAMING MACHINES (EGM and/or EBM) Please be informed of the destruction of the following gaming machines: Item EGM/EBM Manufacturing PAGCOR Manufacturer Game Theme Date Manufactured No. Serial No. Plate No. Inventory Tag No. 1 2 3 (Note: Please use additional sheet/s if the space provided above is not sufficient.) Reason for destruction: B. DETAILS OF TRADITIONAL BINGO EQUIPMENT AND/OR PARAPHERNALIA Please be informed of the destruction of the following Traditional Bingo Equipment and/or Paraphernalia: Item No. Manufacturer Description Quantity Remarks (Model/Code) (Card/Ticket series no./Production no.) . (Note: Please use additional sheet/s if the space provided above is not sufficient) Reason for destruction:: II. ACCOMPANYING DOCUMENTS Copies of the following shipment documents covering the Gaming Machines to be destroyed should be submitted to GLDD along with this request for approval form. A. For supplier whose importation availed of PAGCOR’s Customs and Duties Tax Exemptions: 1. PAGCOR approved Shipment Clearance and Approval Form 2. Previously issued Tax Exemption Indorsement from the Department of Finance (DOF) along with the supporting documents (e.g. importation bill of lading / airway bill and import commercial invoic

Page No. Page 2 of 2 DESTRUCTION OF GAMING EQUIPMENT AND/OR PARAPHERNALIA REQUEST AND Form No. GLDD-840 APPROVAL FORM Revision No. 2 (FOR SUPPLIERS ONLY) Effectivity Feb. 03, 2026 3. Bureau of Internal Revenue – Customs Declaration 4.Assessment Notice 5.Commercial Invoice 6.Packing List and Bill of Lading or Airway Bill 7.Permit/Clearance that other concerned government agencies may require 8.Other items or information that GLDD may require B. For supplier whose importations are covered by an Import Permit filed with a Special Economic Zone Authority and Duties and Taxes are for the account of the Supplier including Traditional Bingo. 1. PAGCOR approved shipment clearance and approval form 2. Certificate of Scrap Buyer’s Registration 3. Commercial Invoice/Tax Invoice 4. packing List and Bill of Lading or Airway Bill 5. Permit/Clearance that other concerned government agencies may require 6. Commercial Invoice 7. Other items or information that GLDD may require In addition to the above documents, the Supplier shall submit a written approval from the Special Economic Zone Authority that issued the Import Permit for the Gaming Equipment allowing for the destruction of the concerned gaming machines. We confirm and undertake to do the following: ▪ The abovementioned undertaking shall be carried out in close coordination with the Compliance Monito ring and Enforcement Department, and the Bureau of Customs (when necessary). ▪ For Enrolled Supplier whose importation availed of PAGCOR’s customs and duties tax exemptions , Disposal shall not be carried out unless PAGCOR has obtained a written approval from the DOF. Printed Name: Signature: Position Title: Date: SECTION B: SUBMISSION INSTRUCTIONS Once Section A is completed, please submit this form to GLDD along with the necessary attachments. Hard copies may be submitted directly to the GLDD office or scanned copies of the documents may be emailed using the e-mail address indicated below: Gaming Licensing and Development Department Philippine Amusement and Gaming Corporation MET Live Building, Central Business Park 1-A Macapagal Boulevard corner EDSA Extension, Pasay City 1300 Tel Nos. (02) 8522-0299 Local 1156 E-mail addresses: [email protected] Note: Please accomplish the Certificate of Destruction of Gaming Equipment and/or Paraphernalia SECTION C: ACTION TAKEN (TO BE FILLED UP BY GLDD) A. RETURNED DUE TO THE FOLLOWING REASONS: Incomplete information and/or supporting documents Incorrect information vis-à-vis supporting documents B. RECEIVED FOR PROCESSING with assigned Reference No. By: Printed Name: ___ Signature: ___________ ___ Position Title: Date: ____________ _C. RECOMMENDATION FOR APPROVAL By: Printed Name: Signature: ___________--_ Position Title: Date: _______ Verified by: Approved by: Senior Manager, CLRD-GLDD Assistant Vice President, GLDD