PAGCOR Forms
OG Form 1176 - Compliance Authorized Representative (Form C)
Page No. Page 1 of 1 Offshore Gaming Employment License (OGEL) Form No. OGLD - 1176 COMPLIANCE AUTHORIZED REPRESENTATIVE (Form C) Rev. No. 4 Effectivity October 17,2023 Name of Company: Business Address: Authorized Representative of Service Provider: Contact Number: DETAILS AUTHORIZED PERSONNEL ALTERNATE AUTHORIZED PERSONNEL NAME: POSITION TITLE: E-MAIL ADDRESS: OFFICE NUMBER: MOBILE NUMBER: SPECIMEN SIGNATURE:
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