Gldd 986 Destruction Of Descontinued Or Counterfeit Gaming Chips Plaques And Other Gaming Paraphernalia Crm F31

DESTRUCTION OF DISCONTINUED Page No. Page 1 of 2 OR COUNTERFEIT GAMING Form No. GLDD - 986 Revision CHIPS/PLAQUES AND OTHER No. 6 GAMING PARAPHERNALIA NOTIFICATION FORM Effectivity Aug. 20, 2025 CRM FORM NO. 31 Use this form to notify PAGCOR regarding destruction of discontinued or counterfeit gaming chips/plaques and other gaming paraphernalia in the casino. Please accomplish this form by providing correct and complete information. The Licensee shall submit this form to GLDD at least one (1) business day prior to intended date of implementation. Licensee : Casino Location : Date : Date of Implementation : SECTION A: PROPOSED DESTRUCTION OF DISCONTINUED OR COUNTERFEIT GAMING CHIPS/PLAQUES AND OTHER GAMING PARAPHERNALIA (TO BE PROVIDED BY LICENSEE) Please be informed of the destruction of the following discontinued or counterfeit gaming chips/plaques and other gaming paraphernalia in the casino: DESCRIPTION TOTAL ITEM MODEL/CODE DENOMINATION QUANTITY VALUE PER NO. (Size, Shape, Colors, etc.) DENO 1 2 3 4 5 6 7 8 9 10 (Note: Please use additional sheet/s if the space provided above is not sufficient) We confirm and undertake to do the following: ▪ Destruction of gaming chips/plaques and other gaming paraphernalia are compliant with Regulation 13 Sections 3, 4 and 5 of the Casino Regulatory Manual for Licensed Land-Based Casinos, whichever is applicable. ▪ Members of the PAGCOR Monitoring Team (PMT) as well as representatives from the Licensee shall witness the destruction procedure. The Licensee and PMT shall ensure that all gaming chips/plaques and other gaming paraphernalia are completely destroyed and rendered unusable for gaming operations. ▪ After destruction, the PMT shall accomplish and sign a “Certificate of Gaming Chips/Plaques and Other Gaming Paraphernalia Destruction Form” to be acknowledged by representatives of the Licensee. Name of Requestor : Signature : Position Title : Date:

DESTRUCTION OF DISCONTINUED Page No. Page 2 of 2 OR COUNTERFEIT GAMING Form No. GLDD - 986 Revision CHIPS/PLAQUES AND OTHER No. 6 GAMING PARAPHERNALIA NOTIFICATION FORM Effectivity Aug. 20, 2025 SECTION B: SUBMISSION INSTRUCTIONS Once Section A is completed, please 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 along with the necessary attachments. 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 C: ACKNOWLEDGEMENT OF NOTIFICATION (TO BE FILLED OUT BY GLDD) RECEIVED with REFERENCE NO. _________________ By: Printed Name: Signature: Position Title: Date: