Gldd 1626 Player Liaison Cancellation Of Approval Form

Page No. Page 1 of 2 PLAYER LIAISON CANCELLATION OF Form No. GLDD - 1626 APPROVAL FORM Revision No. 0 Effectivity July 3, 2025 CRM FORM NO. 71 Use this form to request cancellation of approval from PAGCOR for player liaison of junket groups at the casino. Only requests with correct, complete information, and required attachment(s) will be processed. Failure to provide correct, complete information, and required attachment(s) could result in rejection of processing this request. One (1) application form per junket group policy will be implemented. PLEASE ALLOW FIVE (5) DAYS FOR GLDD TO PROCESS YOUR REQUEST Licensee : Casino Location : Date : Date of Implementation : SECTION A: DETAILS OF PLAYER LIAISON APPROVAL (TO BE PROVIDED BY LICENSEE) GLDD Reference Number: __________________________________________________________ Junket Operator: __________________________________________________________ Name(s) of Player Liaison/s: __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ Please see attached Annex __ for the above player liaison(s) approved by PAGCOR. This is to certify and confirm the cancellation of the above-mentioned player liaison/s. Printed Name: Position Title: Signature: Date: SECTION B: SUBMISSION INSTRUCTIONS Once Section A is completed, please submit this form to GLDD along with the necessary attachments. Hard copies may be submitted directly to the GLDD office or scanned copies may be emailed using the e-mail address of the concerned licensed casino indicated below: Gaming Licensing and Development Department Philippine Amusement and Gaming Corporation 11th Floor MET LIVE BUILDING, Central Business Park 1-A Macapagal Boulevard cor. EDSA Extension, Pasay City 1300 Tel. No. (+632)8522-0299/8522-1357/8522-1324 (Local 1148) E-mail addresses: [email protected] / [email protected] [email protected]/ [email protected] [email protected] / [email protected] [email protected] / [email protected] [email protected] / [email protected] [email protected] / [email protected] [email protected] If submission of this form is done thru e-mail, the Licensee should ensure that the email has been duly received and acknowledged by GLDD. The Licensee shall be notified by GLDD also thru e-mail confirming receipt of this form. If no e-mail confirmation is received from GLDD, the Licensee should submit the hard copy directly to GLDD.

Page No. Page 2 of 2 PLAYER LIAISON CANCELLATION OF Form No. GLDD - 1626 APPROVAL FORM Revision No. 0 Effectivity July 3, 2025 SECTION C: ACTION TAKEN (TO BE FILLED OUT BY GLDD) A. RECEIVED FOR PROCESSING with assigned Reference No. ________________ Printed By: Name: ______________________________ Signature: ________________________ Position Title: ______________________________ Date: ________________________ Approved by: Sr. Regulatory Officer, CLRD REMARKS