Gldd 1489 Player Liaison Clearance Request And Approval Form

Page No. Page 1 of 2 PLAYER LIAISON CLEARANCE Form No. GLDD – 1489 REQUEST AND APPROVAL FORM Revision No. 0 Effectivity July 3, 2025 CRM FORM NO. 70 Use this form to request clearance from PAGCOR for player liaison/s at the casino. Only requests with correct and complete information and complete documentary requirements will be processed. Failure to provide correct and complete information could result in non-processing of the request. One (1) application form per junket group policy will be implemented. PLEASE ALLOW SEVEN (7) DAYS FOR GLDD TO PROCESS YOUR REQUEST Licensee : Casino Location : Date : SECTION A: DETAILS OF PROPOSED PLAYER LIAISON(S) (TO BE PROVIDED BY LICENSEE) This is to request for approval to allow the following player liaison(s) of the junket group to assist in overseeing and managing video streaming of junket tables in licensed casino: New application Renewal Name of Junket Group : Name(s) of Player Liaison(s) : DOCUMENTS FOR SUBMISSION ▪ Certified true copy of valid NBI Clearance Certificate ▪ Valid Employment Identification Card with latest photograph issued by the Junket Operator ▪ Certificate of Training in casino table games issued by any PAGCOR accredited training facility This is to certify that the above document/s for the proposed player liaison(s) is/are authentic. Name of Requestor : Signature : Position Title : Date: SECTION B: SUBMISSION INSTRUCTION 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]

Page No. Page 2 of 2 PLAYER LIAISON CLEARANCE Form No. GLDD – 1489 REQUEST AND APPROVAL FORM Revision No. 0 Effectivity July 3, 2025 SECTION C: ACTION TAKEN (TO BE FILLED OUT BY GLDD) A. RETURNED due to the following reasons: Illegible/unreadable submitted documents Incomplete documentary requirements B. RECEIVED FOR PROCESSING with assigned Reference No. ________________ Printed By: Name: ______________________________ Signature: ________________________ Position Title: ______________________________ Date: ________________________ C. RECOMMENDATION FOR APPROVAL subject to the following: 1. Player Liaison Clearance shall be valid from _______________ to ______________, 20___. 2. Please see the REMARKS below for additional conditions. Printed By: Name: ______________________________ Signature: ________________________ Position Title: ______________________________ Date: ________________________ Verified by: Approved by: Senior Manager, CLRD, GLDD Assistant Vice President, GLDD REMARKS