Personal Disclosure Sheet (PDS) for Key Officers and Authorized Representatives, ROASD-1050, Revision 1

Page No. 1 of 4 PERSONAL DISCLOSURE SHEET Form No. ROASD-1050 FOR KEY OFFICERS AND AUTHORIZED Revision No. 1 REPRESENTATIVE/S Effectivity Sept. 9, 2026 INSTRUCTIONS: 1) Write your answers in block letters. If the information required is not applicable, write “NA” Affix 2 x 2” 2) Place a cross [ X ] in the appropriate box Colored photo here 3) Affix a 2x2 colored photograph taken within the past 6 months 4) Please attach a copy of valid Government issued ID / Passport PART 1: PERSONAL INFORMATION NAME (Last Name) (First Name) (Middle Name) ALIAS / OTHER NAME GENDER Male Female DATE OF BIRTH (Day of Month) (Month in words) (Year in full) NATIONALITY AEP NUMBER (IF APPLICABLE) TAX IDENTIFICATION NUMBER. (TIN) CONTACT INFORMATION: RESIDENTIAL ADDRESS PERMANENT ADDRESS TELEPHONE NUMBER MOBILE NUMBER EMAIL ADDRESS EMPLOYMENT INFORMATION: COMPANY NAME POSITION/TITLE

Page No. 2 of 4 PERSONAL DISCLOSURE SHEET Form No. ROASD-1050 FOR KEY OFFICERS AND AUTHORIZED Revision No. 1 REPRESENTATIVE/S Effectivity Sept. 9, 2026 PART 2 : PROFESSIONAL HISTORY (Please provide your employment/professional history covering the past five (5) to ten (10) years) Please use separate sheet as needed YEAR NATURE OF POSITION COMPANY FROM TO BUSINESS TITLE PART 3 : ALL AFFILIATIONS WITH PAGCOR LICENSES Name/s of registered company/ies of partnership/s PART 4 : INTEGRITY AND FINANCIAL SOUNDNESS The questions below are for any jurisdiction. If you answer “YES” to any question, please provide details in a separate sheet. Indicate offenses and/or circumstances that transpired within and outside the Philippines. 4.1 Have you ever been convicted of any offense? YES NO Have you been charged with an offense and awaiting hearing; or 4.2 otherwise subject to a pending prosecution? YES NO To your knowledge, are you under investigation by  The police, customs or any law enforcement agency YES NO 4.3  Any other government agency YES NO  Any professional body, trade association or industry regulator YES NO Have you ever been censured, disciplined or made subject of an order 4.4 by any professional body, trade association or industry regulator? YES NO Have you ever been:  Disqualified from acting as a director of a company 4.5  Prohibited or prevented from acting in the management or YES NO conduct of the affairs of any company, partnership or association  Dismissed, discharged or asked to resign from any employment

Page No. 3 of 4 PERSONAL DISCLOSURE SHEET Form No. ROASD-1050 FOR KEY OFFICERS AND AUTHORIZED Revision No. 1 REPRESENTATIVE/S Effectivity Sept. 9, 2026 Have you ever held a Directorship or other senior appointment with any company, partnership or business entity which has been placed during your term into 4.6  Liquidation YES NO  Receivership  Insolvency  Any kind of regulatory administration or monitoring Have you in your personal capacity been declared insolvent by a YES NO 4.7 competent regulatory body? PART 5: DECLARATION I certify that the information provided in this PDS is true, complete and correct to the best of my knowledge and based on authentic documents in my possession at the time of execution of this PDS. I undertake to provide any additional information or supporting documents that PAGCOR may reasonably require in relation to this PDS. PART 6: DATA PRIVACY NOTICE AND CONSENT In accordance with the Data Privacy Act of 2012 (R.A. No. 10173), I acknowledge that the personal information and supporting documents provided in this PDS may be collected, processed, stored, used, and disclosed by PAGCOR solely for licensing, accreditation, regulatory, compliance, and verification purposes. Such information shall be protected and processed in accordance with applicable data privacy laws and PAGCOR policies. (For complete details on data handling, retention, security, and your rights under the DPA, please refer to PAGCOR's Data Privacy Statement at www.pagcor.ph/data-privacy-act.php) ☐ I have read and understood the Data Privacy Notice above, and I voluntarily consent to the collection, processing, storage, and use of my personal information for the stated purposes. ☐ I understand that my consent is not the sole legal basis for processing, and that PAGCOR may process my personal information on other lawful grounds permitted under applicable laws and regulations. IN WITNESS WHEREOF, I hereby affix my signature this _____ day of ______________ at _________, Philippines. _____________________________ Affiant SUBSCRIBED AND SWORN to before me this ____ day of ________ at _____________, Philippines, affiant exhibited to me his/her _____________________ issued on ___________ at ________________. Doc. No. ______; Page No. ______; Book No. ______; Series of 20____.

Page No. 4 of 4 PERSONAL DISCLOSURE SHEET Form No. ROASD-1050 FOR KEY OFFICERS AND AUTHORIZED Revision No. 1 REPRESENTATIVE/S Effectivity Sept. 9, 2026 NAME: TYPE OF ID: ID NUMBER: SPECIMEN SIGNATURE: 1. 2. 3. I hereby certify that the above signatures are my true and official specimen signatures, which shall be used for verification in all documents and transactions related to the Company’s licensing application with the Philippine Amusement and Gaming Corporation (PAGCOR). Please attached valid government-issued ID / Passport: (Government-issued ID: front and back with visible signature / Passport: biopage and signature page)