GAMING EQUIPMENT AND PARAPHERNALIA INVENTORY FORM

Page No. Page 1 of 2 GAMING EQUIPMENT AND Form No. EGLD - 1795 PARAPHERNALIA INVENTORY FORM Rev. No. 0 Effectivity July 13, 2026 EG Form No. 59 EGLD Reference No.: Please use this form to submit to EGLD the current inventory of all the gaming equipment and paraphernalia currently located in the gaming venue. Kindly accomplish this form providing correct and complete information. This form shall be part of the requirements for the application for amendment of gaming license due to change in location, relocation, expansion or reduction of gaming venue premises and application for conversion of Standard Gaming License (SGL) to Unified Gaming License (UGL) as well as addition or reduction of ancillary game offering. SECTION A: DETAILS OF THE OPERATOR 1.Name of Operator: ________________________________________________________________ (as reflected in the license) 2.Gaming Venue Address: ________________________________________________________________ (as reflected in the license) 3. Inventory used for:  Gaming License Conversion  Amendment of License due to change in location 4. Gaming License No.: _______________________ GL Validity: (From) ______________ (To) _______________ 5. Existing Game Offering/s: ________________________________________________________________ For Application for SGL to UGL Conversion, kindly indicate GL Nos. before the game offering for the spaces provided below: No. License No. Game Offering GL Validity 1 2 3 4 5 6 SECTION B: LIST OF GAMING EQUIPMENT/ PARAPHERNALIA TYPE OF TERMINAL SUPPLIER / (Electronic Gaming Machine SERIAL PAGCOR ITEM NO. GAME OFFERING MANUFACTURER (EGM) / PC-Type / Tablet / Hybrid / GSA NUMBER TAG NO. EGM) 1 2 3 4 5 6 7 8 (For additional list of equipment/paraphernalia, please use Schedule I) We affirm, declare, and certify that the above-listed items, including those listed in Schedule I (if any), constitute the complete inventory of all gaming equipment and paraphernalia currently located in our gaming venue. We are aware that PAGCOR reserves the right to conduct post-audit of the electronic gaming terminals which have been installed and launched into operation in the gaming venue. We are aware that should any of the gaming equipment and paraphernalia not listed above and in Schedule I (if any) be found within the gaming venue without justifiable cause or prior approval from PAGCOR, we may be held criminally liable under the Philippine laws. Printed Name: ______________________________ Signature: _____________________________ Position Title: _______________________________ Date: _____________________________

Page No. Page 2 of 2 GAMING EQUIPMENT AND Form No. EGLD - 1795 PARAPHERNALIA INVENTORY FORM Rev. No. 0 Effectivity July 13, 2026 SCHEDULE I EGLD Reference No.: __________________ SECTION B: LIST OF GAMING EQUIPMENT/ PARAPHERNALIA (continuation) TYPE OF TERMINAL SUPPLIER / ITEM GAME OFFERING (Electronic Gaming Machine MANUFACTURER / SERIAL PAGCOR NO. (EGM) / PC-Type / Tablet / GSA NUMBER TAG NO. Hybrid EGM)