Shipment Clearance Request and Approval Form, ROASD-1065, Revision-5

PAGE NO. Page 1 of 2 SHIPMENT CLEARANCE REQUEST AND FORM NO. ROASD-1065 APPROVAL FORM REVISION NO. 5 EFFECTIVITY August 4, 2026 Use this form to request shipment clearance from PAGCOR on importations of equipment and/or paraphernalia necessary for accredited data streaming operations. Only requests with correct, complete information and documentary requirements will be processed. Applications with incorrect and/or incomplete information will be returned. Any custom duties and taxes levied on the shipment shall be for the account of the accredited Data Streaming Provider (DSP). PLEASE ALLOW THREE (3) BUSINESS DAYS FOR ROASD TO PROCESS YOUR REQUEST Name of Data Streaming Provider (DSP): ___________________________________________________ Address/Location: ________________________________________________________________________ T.I.N.: ___________________________________________________________________________________ SECTION A: DEPOSIT NOTICE (TO BE FILLED OUT BY ROASD) TO : THE VICE PRESIDENT, FG Requesting the acceptance of One Thousand Pesos (₱1,000.00) representing payment for the shipment processing fee, and the subsequent issuance of the corresponding OFFICIAL RECEIPT. Requested by: Name and Signature: ________________________ OR Number : ______________ Position Title: ______________________________ Date : ______________ SECTION B: SHIPMENT CLEARANCE REQUEST (TO BE FILLED OUT BY DSP) ITEMS TO IMPORT DESCRIPTION QUANTITY PURPOSE/USE SECTION C: CUSTOMS AND DUTIES EXEMPTION (TO BE FILLED OUT BY DSP) Importation of the abovementioned Subject Item(s) is/are: To avail PAGCOR’s Duty/Tax Free privileges. Duty/Tax Free privileges covered under Import Permits filed by DSP with ____________________. Customs and duties taxes shall be for the account of DSP. Shipping Documents Attached: (Put an [X] mark on any of the following) Commercial Invoice No. Tax Invoice No. Invoice Date: Name of Supplier: Address: Supplier’s PAGCOR Registration No. Validity Period: Shipment Point of Origin: Name of Broker: SECTION D: TERMS AND CONDITIONS • A supplier of gaming equipment and paraphernalia, surveillance equipment, I.T. equipment and all other equipment and paraphernalia to be used on the gaming floor must be accredited by PAGCOR. A shipment clearance request on importation from a supplier who is not PAGCOR-accredited shall be rejected by ROASD. • If approval is granted by ROASD on the shipment request, accredited DSP shall ensure that all items shipped shall be strictly within the quantities and description indicated in the PAGCOR approved shipping documents. Items which are found to be in excess of those or are not indicated in the PAGCOR-approved shipping documents shall subject the DSP to sanctions. • A representative from the Compliance Monitoring and Enforcement Department (CMED) shall conduct an inspection and inventory on the same. • Any subsequent movement of said items shall require written notification to PAGCOR prior to implementation. • The importation of the above items is required in the conduct of data streaming operations and that the same are for exclusive use of the DSP only. • Importations/Purchases must only be placed at the address stated in the PTP.

PAGE NO. Page 2 of 2 SHIPMENT CLEARANCE REQUEST AND FORM NO. ROASD-1065 APPROVAL FORM REVISION NO. 5 EFFECTIVITY August 4, 2026 This is to certify that the aforementioned are true, correct, complete and consistent with the attached shipping documents. In addition, we hereby agree to abide by the Terms and Conditions under Section D above. Name of Requestor: Signature: Position Title: Date: Data Streaming Provider: SECTION E: ACTION TAKEN (TO BE FILLED OUT BY ROASD) A. RETURNED / HELD Reason: __________________________________________________________________ B. RECEIVED FOR PROCESSING with assigned Reference No. ________________ Printed By: Name: Signature: Position Title: Date: C. RECOMMENDED FOR APPROVAL Printed By: Name: Signature: Position Title: Date: APPROVED BY: __________________________ Assistant Vice President, ROASD For endorsement to the following department/s: SECTION F: INSPECTION AND INVENTORY OF SHIPMENT TO : THE ASSISTANT VICE PRESIDENT, CMED Request for the following: 1. A representative from CMED, together with the accredited DSP, shall conduct a joint inspection and inventory of the Subject Items to verify that the items shipped are within the approved shipping documents and for inventory purposes, before the same are turnover to the accredited DSP. 2. Submission of an Inspection and Inventory Report to ROASD after the conduct of said activity. 3. CMED ensures that item/s shipped is/are used according to the intended purpose. SECTION G: CUSTOMS AND DUTIES EXEMPTION TO : THE ASSISTANT VICE PRESIDENT, LMD Please refer to Section C for Customs and Duties Exemption of the subject item/s for importation. Also attached for your reference is duly accomplished “Certification” for the said shipment request.