CMED/GLDD Reference No.: _____________

CHANGE IN GAMING SITE OPERATING HOURS

NOTIFICATION FORM

Use this form to notify PAGCOR regarding change in daily operating hours or change in operating hours due to holiday/s of the gaming site. Please accomplish this form by providing correct and complete information. The Operator shall submit this form to CMED (for bingo gaming sites) or GLDD (for non-bingo gaming sites) at least one (1) business day prior to intended date of implementation. Cut-off for submission of notifications shall be 4:00 P.M.

PLEASE NOTE THAT PAGCOR RESERVES THE RIGHT TO CONDUCT POST-AUDIT ON THE CHANGE IN OPERATING HOURS OF THE GAMING SITE.

Name of Operator:

Gaming Site Location:

Type of Game Offering:

SECTION A: REQUEST DETAILS (TO BE FILLED UP BY THE OPERATOR)

A. Change in Daily Operating Hours - From: _______________ To: _______________ Implementation Dates - From: _______________ To: _______________

B. Change in Operating Hours Due to Holiday/s - From: _______________ To: _______________

Implementation Dates - From: _______________ To: _______________ Name of Holiday/s: __________________________________________________________ Reason/s: ________________________________________________________________ ________________________________________________________________

Authorized Signatory:

Signature :

Position Title: Date:

For non-bingo and non-poker gaming sites only:

SECTION B: ENDORSEMENT TO PAGCOR FOR APPROVAL (TO BE FILLED UP BY THE SERVICE PROVIDER)

This is to endorse the notification for change in operating hours of the gaming site as specified above.

By: Printed Name: Signature:

Position Title: Date:

SECTION C: SUBMISSION INSTRUCTIONS

Once Sections A and B are completed, please submit this form to CMED or GLDD, as applicable. Hard copies may be submitted directly to CMED or GLDD office or scanned copies of the documents may be emailed using the e-mail addresses indicated below:

A. Compliance Monitoring and Enforcement Department E-mail addresses: Philippine Amusement and Gaming Corporation ________________________ 3

rd Floor PAGCOR House, 1330 Roxas Boulevard, Ermita, Manila ________________________

Tel. Nos. ___________________________

B. Gaming Licensing and Development Department E-mail addresses: Philippine Amusement and Gaming Corporation gldd.rgucompliance@pagcor.ph 3

rd Floor PAGCOR House, 1330 Roxas Boulevard, Ermita, Manila

Tel. Nos. 522-3429 / 521-1542 loc. 336 or 385

If submission of this notification form is done thru e-mail, the Operator should ensure that it has been duly received and acknowledged by CMED or GLDD. The Operator shall be notified thru e-mail confirming receipt of this notification form. If no e-mail confirmation is received, the Operator should submit the hard copy of the notification form directly to CMED or GLDD.

SECTION D: ACKNOWLEDGEMENT OF NOTIFICATION (TO BE FILLED UP BY CMED/GLDD)

RECEIVED with REFERENCE NO. _________________ By: Printed Name: Signature:

Position Title: Date:

PHILIPPINE AMUSEMENT AND GAMING CORPORATION A Sure Bet for Progress in Gaming, Entertainment and Nation Building

GS FORM NO. 24 (v.2.1) 05.25.2016