APPLICATION FOR THE REFUND OF EXCESS PERFORMANCE CASH DEPOSIT (PCD)

Page No. Page 1 of 2 APPLICATION FOR THE REFUND OF EXCESS Form No. EGLD - 1122 PERFORMANCE CASH Rev. No. 2 DEPOSIT (PCD) Effectivity December 17, 2025 EG Form No. 40-A EGLD Reference No.: SECTION A: GENERAL INSTRUCTIONS 1. Print this form and complete the necessary information in the designated spaces. Kindly ensure that all mandatory fields are filled out accurately and comprehensively. Failure to provide all required information may result in the return of your application. The processing of the refund of excess PCD will commence once all the correct documentary requirements have been submitted. 2. Submit the original copy of the duly completed EG Form No.40-A, along with the required supporting documentation, to the Electronic Gaming Licensing Department (EGLD). 3. For any query regarding your application, you may call tel. no. 8522-0299, 8522-1357, 8522-1245, 8522-1324 loc 1569 or send an email to [email protected]. SECTION B: APPLICATION DETAILS 1. Name of Requesting Party: (as provided in the Gaming License / COA) 2. Gaming Venue / Business Address: (as provided in the Gaming License / COA) 3. Gaming License / Certificate of Accreditation (COA) Details: License / COA No.: Valid until: Game Offering : _________________________ Existing Brand/s (if applicable): ___________________ 4. Amount to be refunded: 5. Authorized Representative: SECTION C: REQUIREMENTS FOR THE APPLICATION OF REFUND OF EXCESS PCD Submitted Documentary Requirements Yes No   1. Notarized Board Resolution signed by the majority of the Board of Directors signifying the request for refund of excess PCD and the assignment / appointment of the  authorized representative to transact/sign the documents relative thereof.   2. Original copy of corresponding PCD Official Receipt (O.R.) issued by PAGCOR. If PCD OR is not available, an Affidavit of Loss and a Board Resolution attesting the same shall  also be submitted.   3. Copy of latest General Information Sheet (GIS) duly acknowledged by the SEC   4. Copy of Certificate of Incorporation   5. Copy of Gaming License / COA (to be Accomplished by EGLD) SECTION D: DECLARATION By signing below, We declare that: 1. The information provided in this application, including all supporting documents, is accurate, truthful, and correct.

Page No. Page 2 of 2 APPLICATION FOR THE REFUND OF EXCESS Form No. EGLD - 1122 PERFORMANCE CASH Rev. No. 2 DEPOSIT (PCD) Effectivity December 17, 2025 EG Form No. 40-A EGLD Reference No.: 2. We agree to adhere to the provisions set forth in the guidelines. 3. We understand that incomplete submission of the requirements will cause the non-processing of the application. Printed Name: Signature: (Authorized Representative) Position-Title: Date: SECTION E: ACTION TAKEN (TO BE ACCOMPLISHED BY EGLD)  RETURNED APPLICATION due to: Incomplete information Applicant / Operator has decided to withdraw its application Non-compliance with the submission of complete documentary requirements  RECEIVED FOR PROCESSING Printed Name: Signature: Position Title: Date: