Gldd 976 Gaming Chips And Plaques Request And Approval Form Crm F15

Page No. Page 1 of 3 GAMING CHIPS AND PLAQUES REQUEST Form No. GLDD-976 AND APPROVAL FORM Revision No. 6 Effectivity Feb. 18, 2026 CRM Form No. 15 Use this form to request approval from PAGCOR of the proposed gaming chips and plaques to be used in the casino. Only request form with correct and complete information will be processed. Failure to provide correct and complete information could result in non-processing of the request. PLEASE ALLOW SEVEN (7) BUSINESS DAYS FOR GLDD TO PROCESS YOUR REQUEST Licensee: Casino Location: Chip/Plaque Manufacturer or Supplier Name: Address: Licensee’s intended use for the chips/plaques: Check the applicable box. For submission of initial/original proposed gaming chips and plaques, fill up Item A of Section A. For submission of modifications to the previously approved gaming chips and plaques, fill up Item B of Section A. SECTION A: DETAILS OF PROPOSED GAMING CHIPS AND PLAQUES (TO BE PROVIDED BY LICENSEE) A. Proposed gaming chips and plaques with corresponding artworks attached as Annex _____ This is also to certify and confirm that the artworks for both gaming chips and plaques, which are drawn to actual size or larger in scale are consistent with PAGCOR’s requirements and indicates, at a minimum, the following: 1. Measurement of thickness, diameter (for chips) and length of sides (for plaques); 2. Exact color and design of each face and edge of the chip and plaque; 3. Security features installed on the chip or plaque features (i.e. RFID Technology and the likes) contained on the gaming chip and plaque; 4. Name of issuing casino inscribed on each face; and 5. Value of the chip or plaque inscribed on each face. B. Proposed modifications to previously approved gaming chips and plaques with corresponding artwork attached as Annex _____ This is also to certify and confirm that the modifications to the artworks for both gaming chips and plaques, which are drawn to actual size or larger in scale are consistent with PAGCOR’s requirements and indicates, at a minimum, the following: 1. Measurement of thickness, diameter (for chips) and length of sides (for plaques); 2. Exact color and design of each face and edge of the chip and plaque; 3. Security features installed on the chip or plaque features (i.e. RFID Technology and the likes) contained on the gaming chip and plaque; 4. Name of issuing casino inscribed on each face; and 5. Value of the chip or plaque inscribed on each face. OTHER DOCUMENTS FOR SUBMISSION The following documents are to be submitted along with this application:

Page No. Page 2 of 3 GAMING CHIPS AND PLAQUES REQUEST Form No. GLDD-976 AND APPROVAL FORM Revision No. 6 Effectivity Feb. 18, 2026 a. From the Chip/Plaque Manufacturer 1. A certification under oath or notarized affirmation, executed by its authorized signatory, that it has a written system of internal control that describes in detail the current administrative, accounting and security procedures which are utilized in the manufacture, storage and shipment of the gaming chips, plaques and related materials. 2. A copy of the written internal control system it employs, which shall include at a minimum, a detailed, narrative description of the procedures and controls implemented to ensure the integrity and security of the manufacturing process, from design through shipment. b. From the Licensee 1. A certification stating that it has conducted due diligence on and is satisfied with the gaming chip/plaque manufacturer’s system of internal control. 2. The internal control procedures it plans to make use of documenting the distribution, redemption, receipt and inventory of gaming chips and plaques. Name of Requestor : Signature : Position Title : Date: SECTION B: SUBMISSION INSTRUCTION Once you have completed Section A above, 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. Hard copies must be submitted directly to PAGCOR: Central Receiving – Records Management Department Philippine Amusement and Gaming Corporation G/F Lobby, MET Live Building Central Business Park 1-A Macapagal Boulevard cor. EDSA Extension Pasay City 1300 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: ACTION TAKEN (TO BE FILLED OUT BY GLDD) Proposed gaming chips and plaques is/are: A. RETURNED due to insufficient details and/or incomplete documentation

Page No. Page 3 of 3 GAMING CHIPS AND PLAQUES REQUEST Form No. GLDD-976 AND APPROVAL FORM Revision No. 6 Effectivity Feb. 18, 2026 B. RECEIVED FOR PROCESSING with assigned REFERENCE NO. _________________ By: Printed Name: Signature: Position Title: Date: C. RECOMMENDATION FOR APPROVAL subject to Licensee’s submission to PAGCOR Evaluating Department of Shipment Clearance Request and Approval Form or to GLDD of Local Purchase Clearance Request and Approval Form covering the importation and/or local purchase of the said gaming chips and plaques. By: Printed Name: Signature: Position Title: Date: Approved by: Senior Regulatory Officer, CLRD