here

RG Form 2 Page No. Page 1 of 1 SELF EXCLUSION APPLICATION Form No. GLDD-889 FORM Revision No. 6 Effectivity August 24, 2026 NEW APPLICATION RE-APPLICATION USE BLOCK LETTERS AND WRITE LEGIBLY PERSONAL INFORMATION (Family Name) (First Name) (Middle Name) ID Presented ID No: Date of Birth Gender Civil Status Nationality Male Female M M D D Y Y Y Y CONTACT INFORMATION Block / House No. Floor / Unit No., Bldg. Street Village / Subdivision City Province Landline Mobile Email Address Gaming establishment e-Games e-Bingo Sports Betting visited regularly: Poker Clubs Casino, pls. specify Requirements: (Please note that application with incomplete requirements may not be processed) 1. Photocopy of government-issued photo ID with signature and birthdate 2. Two (2) 2x2 colored photo 2x2  Must be clear Photo  Taken within the last 6 months prior to application  Full-face view directly facing the camera  No facial accessory (hat, glasses, facemask, etc.) 3. If non-personal submission, selfie or video call is required for confirmation TERMS AND CONDITIONS I understand the content and purpose of this Exclusion application and that the effect of this application is that an Exclusion Order will be enforced which shall exclude myself from entering all gaming establishments and sites operated and licensed / regulated by PAGCOR. I understand that my application for Self-Exclusion will stay in force for a period of: Six (6) months One (1) year Five (5) years I understand that this Exclusion Order is irrevocable for the first six (6) months I understand that PAGCOR will provide my name and particulars to all gaming establishments operated and regulated by PAGCOR for the purpose of banning from playing. I declare that the information provided in this application are true and correct. I declare that I will hold PAGCOR harmless from any claim for damages that may be brought against PAGCOR in any proceeding in relation to this Exclusion Order. I am aware that I shall not be eligible to collect any winnings or recover losses resulting from any gaming activity, while my exclusion period is in effect. (Signature over Printed Name) (Date) ------------------------------------------------FOR PAGCOR USE ONLY----------------------------------------------- RECEIVED/VERIFIED BY CHECKED BY: PROCESSED BY: (Signature over Printed Name/Date) (Signature over Printed Name/Date) (Signature over Printed Name/Date)