Gldd 1026 Shipment Clearance Request And Approval Form Crm F17

DocuSign Envelope ID: D855AD9C-2316-451E-9A04-0943D75172C6 Page No. Page 1 of 3 SHIPMENT CLEARANCE REQUEST AND Form No. GLDD – 1026 APPROVAL FORM Revision No. 3 Effectivity June 1, 2024 CRM FORM NO. 17 Use this form to request shipment clearance from PAGCOR on importations of equipment and/or paraphernalia necessary for the Casino operations. Only requests with correct, complete information and documentary requirements will be processed. Applications with incorrect and/or incomplete information will be returned. PLEASE ALLOW (3) BUSINESS DAYS FOR PAGCOR TO PROCESS YOUR REQUEST. SECTION A: SHIPMENT CLEARANCE REQUEST (TO BE FILLED UP BY LICENSEE) This is to request approval to import: Gaming Table(s) Slot Machine(s) (Put an [X] mark on any of the following) Playing Card(s) Electronic Table Game(s) Slot Spare Part(s) Chips/Plaques Table Layout(s) Game Conversion Kit(s) Surveillance Equipment Slot Machine Signage(s) Gaming Paraphernalia Table & Slot Management System Bill Validator/Acceptor Other ___________________ Description: Purpose/Use of Item Casino Floor (Onsite) Casino Floor (Online) Stock/spare Warranty/replacement Casino Location SECTION A.1.: FOR IMPORTATIONS OF SLOT MACHINE(S), ELECTRONIC TABLE GAME(S), CONVERSION KIT(S) OR CASINO MANAGEMENT SYSTEM (TO BE FILLED UP BY LICENSEE) We are submitting the accompanying Certification/s from International Gaming Laboratory duly recognized by PAGCOR for the following: Slot Machine(s) Game Conversion Kit(s) Electronic Table Game(s) Casino Management System(s) SECTION A.2: CUSTOMS AND DUTIES EXEMPTION (TO BE FILLED UP BY LICENSEE) Importation of the abovementioned Subject Item(s) is/are: For availment of PAGCOR’s Duty/Tax Free privileges. Duty/Tax Free privileges covered under Import Permits filed by Licensee with . Customs and duties taxes for the account of Licensee. Shipping Documents Attached: Commercial Invoice No. (Put an [X] mark on any of the following) Pro- forma Invoice No. Tax Invoice No. Name of Supplier: ________________________________________________________________________________ Address: _______________________________________________________________________________________ Registered Not Registered Validity Period: _______________________________ Shipment of Origin: ___________________________ Name of Broker: _____________________________________ SECTION B: TERMS AND CONDITIONS • Gaming tables, slot machine, electronic table games, playing cards, chips/plaques, surveillance equipment, other gaming equipment, gaming devices, table layouts and casino systems must undergo prior evaluation and approval by PAGCOR, before a Licensee may request shipment clearance for importation of the same, otherwise, the request for shipment clearance shall be rejected by GLDD. • A supplier of gaming equipment and paraphernalia, surveillance equipment, casino systems and all other equipment and paraphernalia to be used in the Casino, must be accredited by PAGCOR. A shipment clearance request on importation from a supplier who is not PAGCOR-accredited shall be returned by GLDD. • If approval is granted by GLDD on the shipment request, Licensee 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 are deemed unauthorized and may be subject to confiscation by appropriate government authorities. PAGCOR reserves the right to disclose such unauthorized items to appropriate government authorities. • Before the shipment is turned over to the Licensee, a representative from 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 casino operations and that the same are for exclusive use of the casino only. 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 B above.

DocuSign Envelope ID: D855AD9C-2316-451E-9A04-0943D75172C6 Page No. Page 2 of 3 SHIPMENT CLEARANCE REQUEST AND Form No. GLDD – 1026 APPROVAL FORM Revision No. 3 Effectivity June 1, 2024 Name of Requestor: Signature: Position Title : Date : Name of Licensee : SECTION C: SUBMISSION INSTRUCTIONS Once Sections A and B are completed, please pay the processing fee then submit this form to PAGCOR along with the necessary attachments directly to the Evaluating Department located at the following PAGCOR offices: Floor Evaluating Department Local PAGCOR Address Nos. Slot Machine Department 8th 2303 MET LIVE BUILDING, Central Treasury Department 9th 1963 Business Park 1-A Macapagal Table Games Department 8th 1865 Boulevard cor. Bingo Department 3rd 7203/7204/7205 EDSA Extension Pasay City 1300 Surveillance Department 7th 2701 Tel. No. (+632)8522- 0299/8522- Information Technology Department 10th 1062 1357/8522-1324 A. RETURNED due to the following reasons: Incomplete information and/or supporting shipping documents Incorrect information vis-à-vis supporting shipping documents Supplier is not PAGCOR-registered No prior review of proposed importation No Certifications from Int’l Gaming Laboratory duly recognized by PAGCOR attached (for Slot Machine(s), Electronic Table Game(s), Game Conversion Kit(s) or Casino Management System(s)) B. RECEIVED FOR PROCESSING with assigned Reference No. By: Printed Name: Signature: Position Title: Date: C. RECOMMENDATION FOR APPROVAL By: Printed Name: Signature: Position Title: Date: Verified by: Approved by: Name and Signature Name and Signature Date: Date: “This shipment approval is valid until .”

DocuSign Envelope ID: D855AD9C-2316-451E-9A04-0943D75172C6 Page No. Page 3 of 3 SHIPMENT CLEARANCE REQUEST AND Form No. GLDD – 1026 APPROVAL FORM Revision No. 3 Effectivity June 1, 2024 For endorsement to the following department/s: INSPECTION AND INVENTORY OF SHIPMENT TO : THE ASSISTANT VICE PRESIDENT, CMED-IR Requesting for the following: 1. A representative from CMED-IR, together with the Licensee, to conduct a joint inspection and inventory of the Subject Items in order to verify that items shipped are within the approved shipping documents and for inventory purposes, before the same are turned over to the Licensee. 2. Submission of an Inspection and Inventory Report to PAGCOR after the conduct of said activity. 3. CMED ensures that item/s shipped is/are used according to the intended purpose. CUSTOMS AND DUTIES EXEMPTION TO : THE ASSISTANT VICE PRESIDENT, LMD Please refer to Section A.2 for Customs and Duties Exemption of the subject item/s for importation. Also attached for your reference is duly accomplished “Certification” for said shipment request.