Certificate of Destruction of Traditional Bingo Equipment, Paraphernalia and/or Component Parts

CERTIFICATE OF DESTRUCTION OF Page No. Page 1 of 1 TRADITIONAL BINGO EQUIPMENT, Form No. GLDD - 839 PARAPHERNALIA AND/OR COMPONENT Revision 0 No. PARTS (FOR SUPPLIERS USE ONLY) Effectivity September 7, 2023 The Supplier shall accomplish this form following the conduct of permanent destruction of traditional bingo equipment, paraphernalia and/or component parts.. Once completed, a copy of this form shall be furnished by the Supplier to each of the following: (a) Compliance Monitoring and Enforcemenmt Department (CMED) and (b) Gaming Licensing and Development Department (GLDD). The Supplier shall provide CMED and GLDD photos of the destruction process. Name of Supplier: Date: Warehouse Address: Date of Destruction: ____________________ Approved per GLDD Reference No.:__________________ Location of Destruction________________________________________________________________ SECTION A: LIST OF DESTROYED TRADITIONAL BINGO EQUIPMENT, PARAPHERNALIA AND COMPONENT PARTS (To be filled up by the Supplier) I. A. DETAILS OF TRADITIONAL BINGO EQUIPMENT, PARAPHERNALIA AND COMPONENT PARTS Please be informed of the destruction of the following traditional bingo equipment, paraphernalia and component parts: ITEM NO. REMARKS MANUFACTURER DESCRIPTION Quantity (Card/Ticket series no. / Production no.) 1 2 3 4 5 6 7 8 9 10 [This covers ten (10) Traditional Bingo Equipment and/or Paraphernalia only. Use additional form for another set of Traditional Bingo Item/s and or Equipment] Attachment: Duly accomplished Form No. ___Destruction of Gaming Equipment and/or Paraphernalia Request and Approval Form, and Inventory Checklist of EGMs and EBMs for destruction. SECTION B: TRADITIONAL BINGO EQUIPMENT, PARAPHERNALIA AND COMPONENT PARTS DESTRUCTION REPORT We affirm and certify that the abovementioned Traditional Bingo Equipment, Paraphernalia and Component Parts are permanently destroyed and are incapable of being used. Once these items are found to be used illegally, the Supplier shall be held liable to PAGCOR. Destruction performed by: Witnessed by: Supplier’s Authorized Representatives: PAGCOR Team Representatives: Printed Name and Signature, Designation Printed Name and Signature, Designation Printed Name and Signature, Designation Printed Name and Signature, Designation