Ship-Out Clearance Request and Approval Form, ROASD-1066, Revision-5

PAGE NO. Page 1 of 3 SHIP-OUT CLEARANCE REQUEST AND FORM NO. ROASD-1066 APPROVAL FORM REVISION NO. 5 EFFECTIVITY August 4, 2026 Use this form to request clearance from PAGCOR to ship-out gaming equipment and/or paraphernalia for the data streaming operations. Only requests with correct and complete information and complete documentary requirements will be processed. Failure to provide correct and complete information could result in rejection of processing this request. PLEASE ALLOW THREE (3) BUSINESS DAYS FOR ROASD TO PROCESS YOUR REQUEST Name of Data Streaming Provider (DSP): __________________________________________________________ Address: ______________________________________________________________________________________ T.I.N.: ______________________________________________________________________________________ Permit to Possess under: _______________________________________________________________________ SECTION A: DEPOSIT NOTICE (TO BE FILLED UP BY ROASD) TO : THE VICE PRESIDENT, FG Requesting the acceptance of the amount of One Thousand Pesos (₱1,000) representing as payment for the ship-out processing fee, and issuance of the corresponding OFFICIAL RECEIPT. Requested by: Printed Name : ___________________ Signature: ________________ Position Title : ___________________ Date : ________________ SECTION A: PAYMENT INFORMATION / DETAILS (TO BE FILLED UP BY ACCREDITED DSP) Nature of Payment Amount OR Number SHIP-OUT PROCESSING FEE ₱1,000.00 Note: 1. Only Cash Deposit will be accepted. 2. Payment should be made before the processing of ship-out clearance 3. Payment should be made at the PAGCOR Cashier’s Office, 9th Floor, MET Live Building, Central Business Park 1-A, Macapagal Boulevard cor. EDSA Extension, Pasay City 1300 SECTION B: SHIP-OUT CLEARANCE REQUEST (TO BE FILLED UP BY ACCREDITED DSP) This is to request approval to Gaming Table(s) Slot Machine(s) ship-out: Playing Card(s) Electronic Table Game(s) (Put an [X] mark on any of the Slot Spare Part(s) Chips/Plaques following) Table Layout(s) Game Conversion Kit(s) Surveillance Equipment Slot Machine Signage(s) Gaming Paraphernalia Other Gaming Equipment Bill Validator/Acceptor Table & Slot Management System Others: ______________ Expected date of ship-out: Reason for ship-out: Mode of ship-out (i.e., by air or by sea): Port of exit: Name of recipient: Destination/Address of recipient: Reference importation documents: Commercial Invoice No. (Put an [X] mark on any of the ff.) Pro-forma Invoice No. Quote No. Reference documents of items for Inventory List of Items for Ship-out attached as Annex A ship-out: Packing List attached as Annex B *Item for ship-out should be accompanied by the proper shipment/importation documents

PAGE NO. Page 2 of 3 SHIP-OUT CLEARANCE REQUEST AND FORM NO. ROASD-1066 APPROVAL FORM REVISION NO. 5 EFFECTIVITY August 4, 2026 Name of Customs Broker: Contact Number: By: Data Streaming Provider Date Authorized Signatory (Signature Over Printed Name) SECTION C: SUBMISSION INSTRUCTIONS Once Section A and B are completed, please submit this form to ROASD together with supporting ship-out documents. Hard copies may be submitted directly to the ROASD office indicated below: Remote Operations and Ancillary Services Department Philippine Amusement and Gaming Corporation 11th Floor, MET Live Building, Central Business Park 1-A, Macapagal Boulevard cor. EDSA Extension, Pasay City 1300 Trunk Line No. 8521-1542 loc. 1195 SECTION D: ACTION TAKEN (TO BE FILLED UP BY ROASD) Ship-out clearance request is: A. RETURNED due to the following reasons: Incomplete information and/or supporting ship-out documents Incorrect information vis-à-vis supporting ship-out documents B. RECEIVED FOR PROCESSING with assigned Reference No. _____________________ By: Printed Name: Signature: Position Title: Date: C. RECOMMENDATION FOR APPROVAL subject to the conduct of inspection and inventory by the Compliance Monitoring and Enforcement Department prior to ship-out of gaming equipment indicated above. By: Printed Name: Signature: Position Title: Date: APPROVED BY: _________________________ Assistant Vice President, ROASD For endorsement to the following department/s: SECTION F: INSPECTION AND INVENTORY OF SUBJECT ITEM/S FOR SHIP-OUT T O: THE ASSISTANT VICE PRESIDENT, CMED Request to conduct an inspection and inventory of the approved item/s prior to ship-out. SECTION G: REQUIRED DOCUMENTATION OF SUBJECT ITEM/S FOR SHIP-OUT T O: THE ASSISTANT VICE PRESIDENT, LMD Request to coordinate with accredited Data Streaming Provider on the documentation that may be needed for the ship-out of the subject item/s. Data Streaming Provider’s Contact Person: _____________________ Telephone No.: _____________________

PAGE NO. Page 3 of 3 SHIP-OUT CLEARANCE REQUEST AND FORM NO. ROASD-1066 APPROVAL FORM REVISION NO. 5 EFFECTIVITY August 4, 2026 Annex A Attachment: INVENTORY LIST OF ITEMS FOR SHIP-OUT PARTICULARS SERIAL NO. MANUFACTURER (Game Name, Brand, QUANTITY UNIT PRICE* TOTAL PRICE NO. Model) (Note: Please use additional sheet/s if necessary) *Unit price refers to the cost of the item indicated in the commercial invoice when it was approved by ROASD for importation.