Gldd 983 Permanent Decommissioning Of Electronic Gaming Machines Notification Form Crm F23

Page No. Page 1 of 2 PERMANENT DECOMMISSIONING OF Form No. GLDD - 983 ELECTRONIC GAMING MACHINES Revision NOTIFICATION FORM 6 No. Effectivity Aug. 20, 2025 CRM FORM NO. 23 Use this form to notify PAGCOR regarding permanent decommissioning of Electronic Gaming Machines (EGMs). Please accomplish this form by providing correct and complete information. The Licensee shall submit this form to GLDD at least seven (7) business days prior to intended date of implementation. PLEASE NOTE THAT PAGCOR RESERVES THE RIGHT TO CONDUCT POST-AUDIT ON THE EGMs WHICH HAVE BEEN DECOMMISSIONED. Licensee : Casino Location : Date : Date of Implementation: SECTION A: PROPOSED PERMANENT DECOMMISSIONING OF EGMs (TO BE FILLED OUT BY THE LICENSEE) I. DETAILS Please be informed of the permanent decommissioning of the following EGMs: PAGCOR Item EGM Serial Manufacturing Date Manufacturer Game Theme Inventory Tag No. No. Plate No. Manufactured No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 (Note: Please use additional sheet/s if the space provided above is not sufficient.) Reason for Decommissioning: II. ACCOMPANYING DOCUMENTS Copies of the following shipment documents covering the EGMs to be decommissioned shall be submitted to GLDD along with this notification form. A. For casinos whose importations availed of PAGCOR’s customs and duties tax exemptions: 1. Indorsement letter from the Department of Finance (DOF) – Revenue Express Lane to the Commissioner of Customs, Manila, granting customs and duties taxes exemption on the shipment; 2. Commercial Invoice, Pro-forma Invoice, Sales Invoice, and Tax Invoice; 3. Packing List and Bill of Lading or Airway Bill;

Page No. Page 2 of 2 PERMANENT DECOMMISSIONING OF Form No. GLDD - 983 ELECTRONIC GAMING MACHINES Revision 6 NOTIFICATION FORM No. Effectivity Aug. 20, 2025 B. For casinos whose importations are covered by an Import Permit filed with a Special Economic Zone Authority: 1. Commercial Invoice, Pro-forma Invoice, Sales Invoice and Tax Invoice; 2. Packing List and Bill of Lading or Airway Bill. In addition to the above documents, the Licensee shall submit a written approval from the Special Economic Zone Authority that issued the Import Permit for the EGMs allowing for the disposal/permanent decommissioning of the concerned EGMs. We confirm and undertake to do the following: ▪ The abovementioned undertaking shall be carried out in close coordination with the Compliance Monitoring and Enforcement Department – Integrated Resorts, PAGCOR Monitoring Team, and the Bureau of Customs (when necessary). ▪ For Licensed Casinos whose importation availed of PAGCOR’s customs and duties tax exemptions, permanent decommissioning shall not be carried out unless PAGCOR has obtained a written approval from the DOF. Name of Requestor : Signature : Position Title : Date: SECTION B: SUBMISSION INSTRUCTIONS Once Section A is completed, please submit this form to GLDD via the PAGCOR Enterprise Content Management System (ECMS) which may be accessed through the following URL: www.ecms.pagcor.ph along with the necessary attachments. Hard copies must be submitted directly to PAGCOR: Central Receiving – Records Management Department Philippine Amusement and Gaming Corporation G/F Lobby, MET Live Building Central Business Park 1-A Macapagal Boulevard cor. EDSA Extension Pasay City 1300 If submission of this form is done through the ECMS, an e-mail notification confirming receipt shall be received. The status of the application can be viewed and monitored through the online account created using the same system. Operator can also download and print the acknowledgment generated as proof of submission. If no e-email notification is received, the Operator may inquire from the Gaming Licensing & Development Department through the contact details: Tel. No. (+632)8522-0299/8522-1357/8522-1324 (Local 1148) Note: Please accomplish the following forms in relation to the permanent decommissioning of EGMs: 1. Form 24 – Certificate of Permanent Decommissioning of Electronic Gaming Machines – to be accomplished and submitted to PAGCOR once permanent decommissioning has been completed 2. Form 25 – Inspection & Inventory Checklist of Component Parts of Electronic Gaming Machines for Permanent Decommissioning – to be attached to Form 24 above 3. Form 26 – Summary Inventory Report of Electronic Gaming Machine Component Parts Salvaged for Future Use – to be attached to Form 24 above 4. Form 28 – EGM Condemnation Plan (Checklist of Electronic Gaming Machines Component Parts for Destruction) – to be attached to Form 24 above SECTION C: ACKNOWLEDGEMENT OF NOTIFICATION (TO BE FILLED OUT BY GLDD) RECEIVED with REFERENCE NO. _________________ By: Printed Name: Signature: Position Title: Date: