Specimen Signature Card. ROASD-1049, Revision 0
Page No. 1 of 1 Form No. ROASD-1049 SPECIMEN SIGNATURE CARD Revision No. 0 Effectivity Jun. 29, 2026 NAME OF COMPANY: TYPE OF LICENSE / ACCREDITATION: APPLICANT’S AUTHORIZED SIGNATORIES SPECIMEN SIGNATURE/S Please honor and recognize the Name Position/Title following signatures: 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. (Note: Please use additional sheet/s if the space provided above is not sufficient) CERTIFICATION This is to certify that the person/s whose signature/s appear above are the duly designated signatory/ies of the Company, authorized to transact solely with PAGCOR and to sign documents for submission to the Remote Operations and Ancillary Services Department (ROASD). The Company acknowledges that any document submitted bearing the signature of a person not identified herein shall not be processed and may be returned by the ROASD. CORPORATE SECRETARY DATE (Signature over Printed Name)
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