1.17 DESTRUCTION OF GAMING EQUIPMENT/PARAPHERNALIA NOTIFICATION FORM

DESTRUCTION OF Page No. Page 1 of 1 GAMING EQUIPMENT/ Form No. EGLD - 429 PARAPHERNALIA Rev. No. 5 NOTIFICATION FORM Effectivity July 13, 2026 EG Form No. 22 CMED Reference No.: _____________________ Use this form to notify Compliance Monitoring and Enforcement Department (CMED) regarding destruction of gaming equipment/paraphernalia in the currently operational gaming venue or live gaming studio set-up. Please accomplish this form by providing correct and complete information. The Operator shall submit this form to CMED at least one (1) business day prior to intended date of implementation. Cut-off for submission of notifications shall be 4:00 P.M. Entity Classification: Gaming Venue Operator (Operator) Game Content Provider (GCP) Name of Operator / GCP: ________________________________________________________________________ (As reflected in the license / accreditation certificate) Gaming Venue / Live Gaming Studio Set-Up: _________________________________________________________________________________________________ (As reflected in the license / PTH Certificate) Gaming License/Accreditation No.: ____________________ PTH No. (For GCP): _______________________________ Type of Game Offering: ___ Date of Implementation: ________________________ SECTION A: PROPOSED DESTRUCTION OF GAMING EQUIPMENT/PARAPHERNALIA (TO BE PROVIDED BY OPERATOR/GCP) Please be informed of the destruction of the following gaming equipment/paraphernalia in the gaming venue / live gaming studio set-up which shall be undertaken at ________________________________________________________________________________________ : (Location where gaming equipment/paraphernalia shall be destroyed) ITEM DESCRIPTION MODEL / CODE QUANTITY NO (Name of Supplier, Size, Shape, Colors, Serial Nos., etc.) 1 2 3 4 5 (Note: Please use additional sheet/s if the space provided above is not sufficient) We confirm and undertake to do the following: § Destruction of gaming equipment and/or paraphernalia is compliant with the applicable provisions set forth under the existing Regulatory Frameworks. § The Operator/GCP shall ensure that all gaming equipment/paraphernalia are completely destroyed and rendered unusable for gaming operations. § After destruction, the Operator/GCP shall accomplish, sign and submit to CMED a duly accomplished and notarized “Certificate of Gaming Equipment/ Paraphernalia Destruction Form” (EG Form No. 23) to be acknowledged by the Operator’s/GCP’s representatives. Printed Name: _____________________________________ Signature: ________________________ (Authorized Representative) Position Title: ____________________________________ Date: ____________________________ SECTION B: SUBMISSION INSTRUCTIONS Once Section A is completed, please submit this form to CMED along with the necessary attachments. Hard copies may be submitted directly to CMED office or scanned copies of the documents may be emailed using the e-mail addresses indicated below: Compliance Monitoring and Enforcement Department E-mail addresses: Philippine Amusement and Gaming Corporation l NCR & Luzon – [email protected] PAGCOR Main Corporate Office, 12th Floor, iMET BPO Towe l Visayas – [email protected] CBP-1A Metropolitan Park, Roxas Boulevard, Pasay City 1300 l Mindanao – [email protected] Tel. Nos. (+632) 8522-0299 / 8522-1357 / 8522-1245 / 8522-1324 E-mail address: - [email protected] Local 5186 (Bingo Games) Local 2404 (Electronic Games) If submission of this notification form is done thru e-mail, the Operator/GCP should ensure that it has been duly received and acknowledged by CMED. The Operator/GCP shall be notified thru e-mail confirming receipt of this notification form. If no e-mail confirmation is received, the Operator/GCP should submit the hard copy of the notification form directly to CMED. SECTION C: ACKNOWLEDGEMENT OF NOTIFICATION (TO BE FILLED UP BY CMED) o RECEIVED with REFERENCE NO.: ______________________ By: Printed Name : _________________________________ Signature: ___________________________ Position Title : _________________________________ Date: ___________________________