APPOINTMENT AS EXCLUSIVE DISTRIBUTOR / RESELLER DECLARATION FORM

APPOINTMENT AS Page No. Page 1 of 4 EXCLUSIVE DISTRIBUTOR / Form No. EGLD - 1787 RESELLER Rev. No. 0 Declaration Form Effectivity July 01, 2026 EG FORM No. 57 Type or print in block letters the needed information on the spaces provided. Put a cross [x] in the box, if one is provided. If a question does not apply to you, write "N/A". Use additional sheet/s for the information whenever necessary. You must provide all required information. Otherwise, this form will be returned. This form shall be accomplished and submitted by the PAGCOR-accredited Gaming Affiliates (i.e., Game Aggregator and/or Game Content Provider) with appointment/assignment from a foreign-based GA and/or GCP of the same category. PAGCOR reserves the right to request additional information.  NEW DECLARATION  ADDITIONAL ___________________________________ Type or print in block letters the needed information on the (Please spacesstate provided. Put aofcross the number [x] in i.e. declaration, the 1box, st , 2nd,ifetc.) one is provided. If a question does not apply to you, write "N/A". Use additional sheet/s for the information whenever  GAME necessary. AGGREGATOR You must ___________________________________ provide all required information. Otherwise, your application will be returned.  GAME PAGCOR CONTENT reserves the right toPROVIDER request additional information. (Please state the date of previous declaration, if any) Cut-off time for submission of registration forms shall be 4:00 P.M. VALIDITY PERIOD: From ____________________ To _____________________* *shall be, at the maximum, co-terminus with the validity of the issued Certificate of Accreditation as a Gaming Affiliate) SECTION A: DETAILS OF PAGCOR-ACCREDITED GAMING AFFILIATE 1. NAME OF COMPANY ___________________________________________________ 2. COMPLETE BUSINESS ADDRESS ___________________________________________________ (Floor, Building Name or Number, Street) ___________________________________________________ (Barangay, Town/City, Postal Code) 3. OFFICE CONTACT DETAILS ______________________ ____________________ (Telephone No.) (Mobile No.) ______________________ (E-mail Address) 4. PAGCOR ACCREDITATION GAME AGGREGATOR Date of accreditation: ____________________ GAME CONTENT PROVIDER Date of accreditation: ____________________ TRADITIONAL BINGO GAMES ELECTRONIC BINGO GAMES ELECTRONIC CASINO GAMES SPORTS BETTING SPECIALTY GAMES NUMERIC GAMES ONLINE POKER GAMES REGISTERED BRAND _____________________________ CERTIFICATE OF ACCREDITATION NO/S. _____________________________ 5. DECLARANT / AUTHORIZED REPRESENTATIVE COMPLETE NAME _______________________________________________ (Family Name/First Name/Middle Name) POSITION/DESIGNATION _______________________________________________ COMPLETE CONTACT DETAILS ______________________ _____________________ (Telephone No.) (Mobile No.) ______________________ (E-mail Address)

APPOINTMENT AS Page No. Page 2 of 4 EXCLUSIVE DISTRIBUTOR / Form No. EGLD - 1787 RESELLER Rev. No. 0 Declaration Form Effectivity July 01, 2026 SECTION B: DETAILS OF FOREIGN-BASED GAMING AFFILIATE 1. NAME OF COMPANY ___________________________________________________ 2. COMPLETE BUSINESS ADDRESS ___________________________________________________ (Floor, Building Name or Number, Street) ___________________________________________________ (City, Country, Postal Code) 3. OFFICE CONTACT DETAILS ______________________ ____________________ (Telephone No.) (Mobile No.) ______________________ (E-mail Address) 4. CATEGORY GAME AGGREGATOR GAME CONTENT PROVIDER 5. BRAND _____________________________ 6. AUTHORIZED REPRESENTATIVE COMPLETE NAME _______________________________________________ (Family Name/First Name/Middle Name) POSITION/DESIGNATION _______________________________________________ COMPLETE CONTACT DETAILS ______________________ _____________________ (Telephone No.) (Mobile No.) ______________________ (E-mail Address) SECTION C: DOCUMENTARY REQUIREMENTS  1. Certified True Copy (CTC) of authenticated or apostilled Board Resolution issued by the Foreign- based Gaming Affiliate for the appointment to the PAGCOR-accredited Gaming Affiliate of same category as Exclusive Distributor/Reseller of their system/game content/product/services/brand.  2. CTC of authenticated or apostilled Exclusive Distributorship Agreement between the Foreign-based Gaming Affiliate and PAGCOR-accredited Gaming Affiliate, signed by both parties.  3. CTC of authenticated or apostilled Secretary’s Certificate for the authority of the Authorized Representative of the Foreign-based Gaming Affiliate to sign for and on behalf of the company.  4. Notarized Secretary’s Certificate stating the authority of the Declarant/Authorized Representative of the PAGCOR-accredited Gaming Affiliate to sign for and on behalf of the company.

APPOINTMENT AS Page No. Page 3 of 4 EXCLUSIVE DISTRIBUTOR / Form No. EGLD - 1787 RESELLER Rev. No. 0 Declaration Form Effectivity July 01, 2026 SECTION D: DECLARATION By signing below, we declare that: 1. The information contained in this form including all documents submitted herein are valid, true and correct. 2. We have executed this statement with the knowledge that misinterpretation or failure to reveal information requested may be deemed sufficient cause for disapproval/denial of the declaration of the appointment as Exclusive Distributor/Reseller. 3. We agree to the following: a. to furnish any further information that PAGCOR may require when considering this declaration b. to notify PAGCOR immediately of any material changes on the information provided in this declaration c. that any person named within this Form is authorized to release any information requested by PAGCOR. 4. The systems/game contents/products/services of Foreign-based Gaming Affiliate is fully compliant with the requirements and provisions of the existing Regulatory Frameworks issued by PAGCOR covering the Business-to-Business (B2B) providers for electronic gaming system and online gaming platform within the Philippine jurisdiction. 5. Any exclusive distributorship agreement shall be automatically deemed void/cancelled once the foreign- based Gaming Affiliate is accredited by PAGCOR. 6. The validity of the Exclusive Distributorship Agreement is co-terminus with the validity of the Certificate of Accreditation issued by PAGCOR 7. In order to establish that the appointment as Exclusive Distributor/Reseller is under control and management of persons of integrity and competence who are of sound character, we hereby grant authorization for PAGCOR to undertake due diligence enquiries, and to request and receive information about the Foreign-based Gaming Affiliate, PAGCOR-accredited Gaming Affiliate and the individuals named from third parties, if any. __________________________________ _________________________________ Signature over printed name of Authorized Signature over printed name of Representative of Foreign-based Gaming Declarant/Authorized Representative of Affiliate PAGCOR-accredited Gaming Affiliate Date: ________________ Date: ______________

APPOINTMENT AS Page No. Page 4 of 4 EXCLUSIVE DISTRIBUTOR / Form No. EGLD - 1787 RESELLER Rev. No. 0 Declaration Form Effectivity July 01, 2026 SECTION E: SUBMISSION INSTRUCTIONS Once Section D is completed, please submit/mail this form to the EGLD together with supporting documents in Section C to the address/e-mail address indicated below: ELECTRONIC GAMING LICENSING DEPARTMENT Philippine Amusement and Gaming Corporation PAGCOR Corporate Office, MET LIVE BUILDING Central Business Park 1-A, Macapagal Boulevard Cor. EDSA Extension, Pasay City, 1300 Tel. Nos. (+632) 8522-0299 Loc. 1574 / 1575 Advance copy/ies may be submitted through [email protected] SECTION F: EVALUATION (TO BE ACCOMPLISHED BY EGLD) EVALUATION OF DOCUMENTS SUBMITTED  Declaration is found to be in order with complete documentary requirements  Returned due to incomplete or incorrect document/information Acknowledged by: __________________________________ __________________________________ (Name of EGLD Evaluator) Authorized Representative Date: __________________ Date: __________________