1.3 PAYMENT PROCESSING REQUEST FORM

ELECTRONIC GAMING LICENSING DEPARTMENT PAGE NO. Page 1 of 1 FORM NO. EGLD - 417 PAYMENT PROCESSING REQUEST FORM REVISION NO. 9 Remote Games EFFECTIVITY July 13, 2026 EG Form No. 2 Use this form to transmit payment/s for fees/financial requirements due to PAGCOR. Only request forms with correct and complete information and supporting documents will be processed. Failure to provide correct and complete information could result in non-processing of this request. It is understood that Check payments shall be subject to three (3) days clearing period before an Official Receipt is issued by FMD. In the event that a check is returned by the bank due to insufficient funds or any other reason, the Accredited Provider / Administrator / IR Licensee / Applicant / Operator shall settle the amount in cash or by issuing a Manager’s Check. SECTION A: PAYMENT INFORMATION / DETAILS (TO BE ACCOMPLISHED BY ACCREDITED PROVIDER / ADMINISTATOR / IR LICENSEE / APPLICANT / OPERATOR) Name of Accredited Provider / Administrator / IR Licensee / Applicant / Operator: _________________________________________________________________________________________ Complete Business / Gaming Venue Address: ___________________________________________________ SGL/UGL, PTH or COA No. (as applicable): ______________________ TIN No.________________________ SECTION B: PAYMENT DETAILS Payment Type:  Cash  Check  Bank Deposit  Online Bank Transfer  Paid through PAGCOR-Cashier Amount Date Name of Bank / Branch Check No. For bank deposits, please attach a copy of bank validated deposit slip. Type of Fees:  Application Fee  Extension Fee  Performance Cash Deposit (PCD)  Renewal Fee  Accreditation Fee  Processing Fee  Inspection Fee  Penalty / Interest  Other Fees, specify: ___________ Type of Application / Accreditation:  Gaming Venue - Unified Gaming License (UGL)  Gaming Venue - Standard Gaming License (SGL)  Gaming System Administrator (GSA)  Permit to Hold (PTH)  Business to Business (B2B) Provider  Game Aggregator  Game Content Provider  Support Service Provider (SSP)  Independent Game Testing Laboratory  Payment Gateway Solution  Marketing / Promotional Service  KYC / Membership System  Customer Service  Others, specify: __________________ Game Offering/s: ________________________________________________________ Brand / GSA / Supplier ________________________________________________________ Total Amount Paid / Deposited: ______________________________________ Applicant’s / Licensee’s Authorized Signatory: ______________________________________ (Signature over printed name and Date ------------------This portion is to be filled up by EGLD------------------ Recommendation: ______________________________________________ Checked by: ____________________________________________ Signature Over Printed name and Date SECTION C: PAYMENT INSTRUCTIONS Once Section A is completed, please submit this form together with Please indicate the name of the Accredited Provider / Administrator / supporting payment document/s as indicated below: IR Licensee / Applicant / Operator and business gaming venue address on the deposit slip and email along with this EG Form No. 2 within twenty four (24) hours to: Electronic Gaming Licensing Department [email protected] and [email protected] Philippine Amusement and Gaming Corporation [email protected] (Application, Renewal, Extension, 10th Floor MET Live Building, Central Business Park 1-A, Inspection, Reprinting of Gaming License & PCD) Macapagal Boulevard cor. EDSA Extension, Pasay City 1300 [email protected] (Penalty & Interest) Tel. Nos. (+632) 8522-0299 Loc. 1561/1567/1569/1574/1575 [email protected] (PCD, Extension) [email protected] (Accreditation Fee and PCD) For cash/check payments, please proceed to: Disbursing Division, Fund Management Department For deposits to PAGCOR OPEX Account, bank details are as follows: Philippine Amusement and Gaming Corporation Account Name: PAGCOR OPEX Fund 9th Floor MET Live Building, Central Business Park 1-A, Account No: C/A No. 3402-1036-70 Macapagal Boulevard cor. EDSA Extension, Pasay City 1300 Land Bank Branch: LBP Plaza, Malate, Manila