PAGCOR Forms

1.26 CERTIFICATE OF NON-FILING OF ANNUAL INCOME TAX RETURN

Page No. Page 1 of 1 CERTIFICATE OF NON-FILING OF ANNUAL Form No. EGLD - 438 INCOME TAX RETURN Rev. No. 4 (Board of Directors) Effectivity October 23, 2023 EG Form No. 33 NAME OF BOARD MEMBER COMPANY NAME GAME OFFERING SERVICE PROVIDER/S BRAND/S GAMING VENUE I hereby certify that I did not file my Income Tax Return (ITR) for CY _____, as prescribed under the provisions of the NIRC of 1997 and its amendments Title II Chapter IX, Sec. 51.A.2. Attached are the pertinent documents to support my claim: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Signature: _____________________ Date: ______________ IN WITNESS WHEREOF, this certification has been signed this ___ day of ___________ , 20____ at _____________, Philippines. SUBSCRIBED AND SWORN to before me, a Notary Public and in the City/Municipality of _________, Philippines, personally appeared _________________ with his/her Identification No. ______________ issued at _______________ on ___________, known to me to be the same person who executed the foregoing instrument and acknowledged to me that the same is his/her own free and voluntary act and deed. Doc. No. ___________________; Page No. ___________________; Book No. ___________________; Series of 20__.

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