Supplier Ship-out Clearance Request and Approval Form

Page No. Page 1 of 3 SUPPLIER SHIP-OUT CLEARANCE Form No. GLDD-1015 REQUEST AND APPROVAL FORM Revision No. 5 Effectivity Feb. 03, 2026 Use this form to request clearance from PAGCOR when shipping out gaming equipment, spare parts and/or gaming paraphernalia from the Supplier’s storage facility. Only request with correct and complete information and complete documentary requirements will be received. Otherwise said request will be returned. PLEASE ALLOW SEVEN (7) BUSINESS DAYS FOR GLDD TO PROCESS YOUR REQUEST SECTION A: SHIP-OUT CLEARANCE REQUEST (TO BE FILLED UP BY THE SUPPLIER) Name of Supplier: Implementation Date: Permit No.: Validity: Type of items for ship-out: (Put an [X] mark on any of the ff.) Gaming Table Bingo machine or console Playing Cards Chips/Plaques Game Slot Machine Spare parts/ Accessories Conversion kits Gaming Table Layout Signages Surveillance Equipment Casino Management System for Tables, Slots or Ebingo Gaming Paraphernalia Bingo Flashboard Slot Machine Bingo Paraphernalia Electronic Table Game Terminals Bingo Tickets Electronic Bingo Machine/Terminals Bingo Balls Others ___________________ Attachment: Inventory List of Items for Ship-out Description of Subject Item(s): Reason for ship-out: Destination: Reference shipment invoice of items Commercial Invoice No.___________________________ To be ship-out (Put an [X] mark on any of the ff) Tax Invoice No. _____________________________ Custom Broker: Telephone no. By: Supplier’s Authorized Signatory Date (Signature over Printed Name )

Page No. Page 2 of 3 SUPPLIER SHIP-OUT CLEARANCE Form No. GLDD-1015 REQUEST AND APPROVAL FORM Revision No. 5 Effectivity Feb. 03, 2026 SECTION B: SUBMISSION INSTRUCTIONS Once Section A is completed, please submit this form to GLDD together with supporting ship-out documents. Hard copies may be submitted directly to the GLDD office on the address indicated below: Gaming Licensing and Development Department Philippine Amusement and Gaming Corporation MET Live Building, Central Business Park 1-A Macapagal Boulevard corner EDSA Extension, Pasay City 1300 Tel No: ( + 6 3 2 ) 8 5 2 2 - 0 2 9 9 / 8 5 2 2 - 1357/8522-1245/8522-1324, local 1600 OR you may send a scanned copy of this form together with the necessary attachments thru email to: [email protected] SECTION C: ACTION TAKEN (TO BE FILLED UP BY GLDD) A. RETURNED due to the following reasons: Incomplete information and/or supporting shipment invoice Incorrect information vis-à-vis supporting shipment invoice B. RECEIVED FOR PROCESSING with assigned Reference No. By: Printed Name: Signature: Position Title: Date: C. RECOMMENDATION FOR APPROVAL By: Printed Name: Signature: Position Title: Date: Verified by: Approved by: ______________________ __ __________________________ Senior Manager, CLRD, GLDD Assistant Vice President, GLDD

Page No. Page 3 of 3 SUPPLIER SHIP-OUT CLEARANCE Form No. GLDD-1015 REQUEST AND APPROVAL FORM Revision No. 5 Effectivity Feb. 03, 2026 ATTACHMENT: INVENTORY LIST OF ITEMS FOR SHIP-OUT Particulars PAGCOR Items to be (Game Name, Inventory Tag No. Manufacturer Serial Remarks Transferred Brand, Model) No. Number 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. (NOTE: Please use additional sheet/s if the space provided is not sufficient)