Egld 442 Eg Form No 38 Amendment Of Gaming License Due To Change In Location

REQUEST FOR Page No. Page 1 of 3 AMENDMENT TO GAMING Form No. EGLD – 442 LICENSE FORM DUE TO Rev. No. 9 Change in Location Effectivity December 23, 2025 EG Form No. 38 EGLD Reference No.: _________________ SECTION A: GENERAL INSTRUCTIONS 1. Use this form if the Operator intends to request for an amendment to an existing Gaming License (GL) due to a change in the location of the gaming venue. 2. The Operator must provide all required information. Incomplete submissions shall not be processed. 3. Email the clear scanned copies of duly accomplished form together with the prescribed documentary requirements to: [email protected] 4. Acceptance of the request and receipt of documents does not guarantee approval of the application. The issuance of an amended GL remains subject to the approval of the PAGCOR Board. 5. Cut-off for submission of applications is 4:00 P.M. Note: For inquiries regarding your application, you may call tel. no. 8521-1542, 8522-0299 loc. 1561 or send an email to the address above. SECTION B: APPLICATION DETAILS Name of Operator: ____________________________________________________________________ (please provide complete registered name) License Reg No.: ________________________ Current GL Validity: ________________________ Proposed Gaming Venue: ________________________________________________________________ (Unit No / House No. / Floor Level / Building Name / Street Name) ________________________________________________________________ (Barangay / Town / City / Municipality / Province) Current Gaming Location: ________________________________________________________________ Game Offering Details: Game Offering: __________________________ Brand/s: __________________________ Gaming System Administrator/s (as applicable): _________________________________________ Reason for Transfer: _______________________________________________________________ Authorized Representative/s: _______________________________________________________________ SECTION C: INITIAL SITE REQUIREMENTS FOR CHANGE IN LOCATION Submitted Yes No Documentary Requirements   1. Location Map of proposed venue showing distances to schools, churches and existing/approved PAGCOR-EGLD licensed gaming venues   2. Mayor’s Permit or Business Permit of the existing gaming site   3. Copy of Lease Offer, Tax Declaration, Transfer Certificate of Title (TCT), as applicable   4. Original and Notarized Sworn Secretary’s Certificate indicating the Board Resolution stating the company’s decision to transfer its existing gaming venue to the proposed location and designation of Authorized Representative of the company   5. For proposed gaming venue located within commercial building an Original and Notarized Sworn Undertaking indicating that the Applicant has conducted due diligence and surveyed the area where the proposed gaming venue will be located and is confirming that the proposed location is compliant with distance requirements from schools, places of worship, and from another gaming venue   6. Original and Notarized Sworn Certification from a duly licensed geodetic engineer confirming that the proposed gaming venue location classified as commercial building is compliant with the site location distance requirements, may be required   7. For proposed gaming venue located within a hotel or resort, a copy of the applicable (to be accomplished Certificate of Accreditation issued by Department of Tourism (DOT) by EGLD)

SECTION D : DECLARATION REQUEST FOR Page No. Page 2 of 3 AMENDMENT TO GAMING Form No. EGLD – 442 LICENSE FORM DUE TO Rev. No. 9 Change in Location Effectivity December 23, 2025 EG Form No. 38 EGLD Reference No.: _________________ SECTION D: GAMING SITE AREA CLASSIFICATION AND DISTANCE REQUIREMENTS Gaming Area Classification Applied for: ______ Mall ______ PAGCOR Licensed Casinos ______ Commercial Building ______ PAGCOR Regulated Casinos ______ DOT accredited Hotel ______ Cockpit Arenas ______ DOT accredited Resort ______ Horse Racing Tracks SECTION E: GAMING SITE DISTANCE REQUIREMENTS/RESTRICTIONS *Pursuant to Section 1 Article III of the Regulatory Framework for the Issuance of Gaming License for the Establishment of Gaming Venues Rev. 1, Applicants are required to disclose the following: Nearest School/s - (DepEd or CHED-registered institution, excluding post-graduate courses, review centers, research, and special training facilities) Distance from proposed Name of Institution gaming venue ___________________________________________________________________ _______________________ ___________________________________________________________________ _______________________ ___________________________________________________________________ _______________________ ___________________________________________________________________ _______________________ ___________________________________________________________________ _______________________ Nearest Places of Worship/s (Stand-alone places of worship) Distance from proposed Name of Institution gaming venue ___________________________________________________________________ _______________________ ___________________________________________________________________ _______________________ ___________________________________________________________________ _______________________ ___________________________________________________________________ _______________________ ___________________________________________________________________ _______________________ Nearest PAGCOR-EGLD Licensed gaming venues Distance from proposed Name of Operator gaming venue ___________________________________________________________________ _______________________ ___________________________________________________________________ _______________________ ___________________________________________________________________ _______________________ ___________________________________________________________________ _______________________ ___________________________________________________________________ _______________________ SECTION F: DECLARATION By signing below, We declare that: 1. The information contained in this request including all documents submitted relative to this are valid, true, and correct; 2. We declare and certify that we are: a. The same business entity who is the licensed Operator of the existing gaming venue. b. The proposed location of the gaming venue is within the same city or municipality as the existing site. c. The existing gaming venue must have a valid Business Permit. 3. We understand that validity of the amended Gaming License (GL) shall be the unexpired term of the original GL.

REQUEST FOR Page No. Page 3 of 3 AMENDMENT TO GAMING Form No. EGLD – 442 LICENSE FORM DUE TO Rev. No. 9 Change in Location Effectivity December 23, 2025 EG Form No. 38 EGLD Reference No.: _________________ SECTION F: DECLARATION 4. We understand that at this point, PAGCOR does not require any contractual agreement for the proposed gaming venue. Only in the event of PAGCOR's issuance of the amended GL shall We execute such agreement and likewise commence with the renovation of the site. We will not hold PAGCOR liable for any rental/construction expenses that we may incur relative thereto. 5. We have executed this statement with the knowledge that misrepresentation or failure to reveal information requested may be deemed sufficient cause for revocation of the GL of the gaming venue if amendment to GL has been approved by the time such misrepresentation or act of omission is discovered. 6. We are certifying that we have conducted due diligence and surveyed the area where the proposed gaming venue will be located and is confirming that the proposed location is compliant with the distance requirements from schools, places of worship, and from another gaming venue. 7. We are certifying that the proposed gaming venue is compliant with the LGU's requirements and regulations on the establishment; and that we will not hold PAGCOR liable for expenses/"business losses" brought about by closure orders and/or penalties incurred should site be found non-compliant with LGU regulations. 8. We declare that we shall undertake to secure an amended Business Permit to correspond with the new address of the gaming venue, should our request be approved, and submit the same to EGLD in compliance with the prescribed annual submission of documents. Printed Name: ____________________________________ Signature: ______________ (Authorized Signatory) Position Title: ____________________________________ Date: ______________ SECTION G: ACTION TAKEN (TO BE ACCOMPLISHED BY EGLD)  RETURNED APPLICATION due to: _____ Incomplete information _____ Proposed gaming venue is included in the list of saturated areas _____ Proposed gaming venue has reached the maximum allowed co-location _____ Applicant has decided to withdraw its application _____ Non-compliance with the submission of complete documentary requirements and/or failure to pay the applicable fees within the prescribed period _____ Non-compliance with the requirements for Application for Change in Location  RECEIVED FOR PROCESSING with REFERENCE NUMBER: ____________________ Printed Name: ____________________________________ Signature: ______________ Position Title: ____________________________________ Date: ______________