Form

GAMING SITE OPERATORS’ Page No. Page 1 of 2 AUTHORIZED SIGNATORY AND Form No. EGLD - 1309 CONTACT INFORMATION Revision. No. 3 (Remote Games) Effectivity August 17, 2023 Corporation Name: ______________________________________________________________________ Gaming Site Name / Trade Name: __________________________________________________________ Game Offering/s: _______________________________________________________________________ CONTACT INFORMATION Main Office Address: ____________________________________________________________________ Telephone / Mobile Nos.: Official E-mail Address/es: Multiple Sites: (1) __________________________ (1) _________________________ Yes (2) __________________________ (2) _________________________ No AUTHORIZED REPRESENTATIVES AND SIGNATORIES For multiple gaming sites with different authorized/alternate signatories and representatives per gaming site, pls use Schedule 1 1. Authorized Signatory/ies Name Position Specimen Signature 2. Alternate Signatory/ies Name Position Specimen Signature 3. Authorized Signatories on Operational Requests (or Gaming Site Forms) Name Position Specimen Signature 4. Authorized Person/s to Transact with PAGCOR (Compliance) Name Position Contact / Mobile Nos. I have read, understood, and consented to PAGCOR’s Privacy Notice and Privacy Policy. I hereby certify that the foregoing Officers of the Corporation as indicated above / attached schedule are authorized to act, sign, execute, and/or deliver any and all documents, instruments, for and in behalf of the Corporation. IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of ______________ at ___________. CORPORATE SECRETARY SUBSCRIBED AND SWORN to before me this __________ day of _________________ by affiant who exhibited to me his/her Community Tax Certificate/Passport Number _________________ issued at ___________________ on _________________________. Doc No. __________ Page No. __________ Book No. __________ Series of __________

GAMING SITE OPERATORS’ Page No. Page 2 of 2 AUTHORIZED SIGNATORY AND Form No. EGLD - 1309 CONTACT INFORMATION Revision. No. 3 (Remote Games) Effectivity August 17, 2023 Schedule 1 Corporation Name: ______________________________________________________________________ LIST OF GAMING SITES Additionally, fill-up this form for Operators with multiple gaming sites which have designated various authorized signatories and/or representatives for each gaming site: Gaming Site Authorized Authorized Authorized to Signatories Contact Name and Site Signatories Transact with (Operational Request/ Information Address (Correspondences) GS Form) PAGCOR 1. Name/Position: Name/Position: Name/Position: Tel / Mobile Nos.: Specimen Signature: Specimen Signature: Email: 2. Name/Position: Name/Position: Name/Position: Tel / Mobile Nos.: Specimen Signature: Specimen Signature: Email: 3. Name/Position: Name/Position: Name/Position: Tel / Mobile Nos.: Specimen Signature: Specimen Signature: Email: 4. Name/Position: Name/Position: Name/Position: Tel / Mobile Nos.: Specimen Signature: Specimen Signature: Email: 5. Name/Position: Name/Position: Name/Position: Tel / Mobile Nos.: Specimen Signature: Specimen Signature: Email: *repeatedly use this page for additional gaming sites