1.31 REQUEST FOR AMENDMENT TO GAMING LICENSE FORM (RELOCATION WITHIN THE SAME BUILDING, COMPOUND OR COMPLEX)

REQUEST FOR Page No. Page 1 of 2 AMENDMENT TO GAMING Form No. EGLD – 391 LICENSE FORM Due to Relocation within the Same Rev. No. 2 Building, Compound, or Complex Effectivity December 23, 2025 EG Form No. 39 EGLD Reference No.: _________________ SECTION A: GENERAL INSTRUCTIONS 1. Use this form if the Operator intends to request for relocation and/or expansion/reduction of gaming venue within the same building, compound, or complex. 2. The Operator must provide all required information. Incomplete submissions shall not be processed. 3. Email the clear scanned copies of the duly accomplished form, together with the prescribed documentary requirements, to: [email protected] 4. Acceptance of the request and receipt of documents does not guarantee approval of the application. The issuance of an amended Gaming License remains subject to the approval of the PAGCOR Board, as applicable. 5. Cut-off for submission of applications:4:00 P.M. Note: For inquiries regarding your application, please call (02) 8521-1542 /8522-0299 loc. 1561 or email the address above. SECTION B: APPLICATION DETAILS Name of Operator: _____________________________________________________________________________ (Complete registered name) License Registration No.: _________________________ Current GL Validity: __________________________ Current Gaming Venue Address: ___________________________________________________________________ (as indicated in the Gaming License) Proposed Gaming Venue Adress: ___________________________________________________________________ (Unit House No. / Floor Level / Building Name / Street Name) ___________________________________________________________________ (Barangay / Town / City / Municipality / Province) Game Offering Details: Game Offering: ___________________________ Brand/s: ___________________________ Gaming System Administrator/s (as applicable): _______________________________________________ Reason for Relocation / Expansion / Reduction: ________________________________________________________ Authorized Representative/s: _______________________________________________________________________ SECTION C: INITIAL SITE REQUIREMENTS FOR RELOCATION Submitted Yes No Documentary Requirements   1. Valid Business Permit of the existing gaming venue   2. Layout plan of the existing site and the proposed transfer location within the same building, compound, or complex   3. Site concept renderings of the proposed transfer location   4. Original and Notarized Secretary’s Certificate indicating the Board Resolution stating the company’s decision to relocate its existing gaming venue to the proposed location and designation of Authorized Representative of the company   5. Closing Inventory List (EG Form No. 37) enumerating the list of all gaming equipment and paraphernalia currently located at the existing gaming venue   6. Payment of Inspection Fee (to be accomplished by EGLD)

REQUEST FOR Page No. Page 2 of 2 AMENDMENT TO GAMING Form No. EGLD – 391 LICENSE FORM Due to Relocation within the Same Rev. No. 2 Building, Compound, or Complex Effectivity December 23, 2025 EG Form No. 39 EGLD Reference No.: _________________ SECTION D: DECLARATION By signing below, We declare that: , including all documents submitted in relation hereto are valid, 1. The information contained in this request true, and correct; 2. We declare and certify that we are: a. The same business entity who is the licensed Operator of the existing gaming venue. b. The proposed location of the gaming venue is within the same building, compound or complex. c. The existing gaming venue has a valid Business Permit. 3. We understand that validity of the amended Gaming License (GL) shall be the unexpired term of the original GL. 4. We understand that at this point, PAGCOR does not require any contractual agreement for the proposed gaming venue. Only in the event of PAGCOR's issuance of the amended GL shall We execute such agreement and likewise commence with the renovation of the gaming venue. We will not hold PAGCOR liable for any rental/construction expenses that we may incur relative thereto. 5. We have executed this statement with the knowledge that misrepresentation or failure to reveal information requested may be deemed sufficient cause for revocation of the GL of the gaming venue if amendment to GL has been approved by the time such misrepresentation or act of omission is discovered. 6. We certify that the proposed gaming venue is compliant with LGU's requirements and regulations on the establishment; and that we will not hold PAGCOR liable for expenses/"business losses" brought about by closure orders and/or penalties incurred should site be found non-compliant with LGU regulations. 7. We declare that we shall undertake to secure an amended Business Permit to correspond with the new address of the gaming venue, should our request be approved, and submit the same to EGLD in compliance with the prescribed annual submission of documents. Printed Name: ____________________________________ Signature: ______________ (Authorized Signatory) Position Title: ____________________________________ Date: ______________ SECTION E: ACTION TAKEN (TO BE ACCOMPLISHED BY EGLD)  RETURNED APPLICATION due to: _____ Incomplete information _____ Applicant has decided to withdraw its application _____ Non-compliance with the submission of complete documentary requirements and/or failure to pay the applicable fees within the prescribed period _____ Non-compliance with the requirements for Application for Change in Location / Relocation and/or Expansion / Reduction _____ Expired GL or non-filing of the required extension for renewal  RECEIVED FOR PROCESSING with REFERENCE NUMBER: ____________________ Printed Name: ____________________________________ Signature: ______________ Position Title: ____________________________________ Date: ______________