Gldd 972 Egm Game Conversion (For Server Supported Egms Crm F11a

ELECTRONIC GAMING MACHINE Page No. Page 1 of 2 GAME CONVERSION NOTIFICATION Form No. GLDD-972 Revision FORM No. 6 (FOR SERVER SUPPORTED EGMs) Effectivity Aug. 20, 2025 CRM FORM NO. 11A (FOR SERVER SUPPORTED EGMs) Use this form to notify PAGCOR regarding game conversion of Server Supported Electronic Gaming Machines (EGMs) in the casino. Please accomplish this form by providing correct and complete information. The Licensee shall submit this form to the PAGCOR Monitoring Team at least thirty (30) minutes prior to start of game conversion. PLEASE NOTE THAT PAGCOR RESERVES THE RIGHT TO CONDUCT POST-AUDIT OF THE GAME CONVERSION OF EGMs IN THE CASINO. Licensee : Name of Casino : Date of Game Conversion : Time of Game Conversion: SECTION A: EGMs GAME CONVERSION (TO BE PROVIDED BY LICENSEE) DETAILS OF THE SERVER SUPPORTED EGM Manufacturer EGM Number Machine Serial Number PAGCOR Tag Number Final Meter Reading (prior to game conversion) GAME THEME(S) FROM GLDD REF. NO.* TO GLDD REF. NO.* (Additional sheet/s may be used if the space above is not sufficient) * Reference number of the Game Library Notification Form (Form No. 67) previously submitted to and acknowledged by GLDD, containing the above game theme(s) and its corresponding parameter settings. Name of Requestor : Signature : Position Title : Date:

ELECTRONIC GAMING MACHINE Page No. Page 2 of 2 GAME CONVERSION NOTIFICATION Form No. GLDD-972 Revision FORM No. 6 (FOR SERVER SUPPORTED EGMs) Effectivity Aug. 20, 2025 SECTION B: SUBMISSION INSTRUCTIONS Once Section A is completed, please submit this form to the PMT. Hard copies may be submitted directly to the PMT office. If submission of this notification form is done thru e-mail, the Licensee should ensure that it has been duly received and acknowledged by PMT. The Licensee shall be notified by the PMT thru e-mail confirming receipt of this notification form. If no e-mail confirmation is received from the PMT, the Licensee should submit the notification form’s hard copy directly to the PMT. SECTION C: ACKNOWLEDGEMENT OF NOTIFICATION (TO BE FILLED OUT BY PMT) By: Printed Name: Signature: Position Title: Date: Time: Upon accomplishment of Sections A and C of this Electronic Gaming Machine Game Conversion Form for Server Supported EGMs, the PMT shall submit this form to GLDD via the PAGCOR Enterprise Content Management System (ECMS) which may be accessed through the following URL: www.ecms.pagcor.ph. If submission of this form is done through the ECMS, an e-mail notification confirming receipt shall be received. The status of the application can be viewed and monitored through the online account created using the same system. Operator can also download and print the acknowledgment generated as proof of submission. If no e-email notification is received, the Operator may inquire from the Gaming Licensing & Development Department through the contact details: Tel. No. (+632)8522-0299/8522-1357/8522-1324 (Local 1148) SECTION D: GLDD’S ACKNOWLEDGEMENT RECEIPT (TO BE FILLED OUT BY GLDD) RECEIVED with REFERENCE NO. _________________ By: Printed Name: Signature: Position Title: Date: