Gs Form. No. 3 - Request For Renewal Of Gaming License Form (Page 2 of 2) in pdf

Gs Form. No. 3 - Request For Renewal Of Gaming License Form Page 2

GS Form. No. 3

(v.1.1) 05.25.2016

This is to signify intent of the Operator to renew Gaming License indicated above and is

accompanied by :

PhP 30,000.00 Renewal Fee for Electronic Games or Bingo Games, or

PhP 15,000.00 Renewal Fee for Poker Games, or

PhP 2,500.00 Renewal Fee for MSW Sports Betting

Payments for demerits incurred during the current Gaming License period (P1,000.00 per 1 point demerit)

Operator's Performance Score Card

Date issued:

We also certify our compliance with the submission of the following documents and other renewal

requirements:

Valid Business Permit

Date issued:

Updated GIS or DTI Registration

Company ITR for the previous year duly filed with the BIR

City/Municipal Council Resolution or Ordinance stating its no objection to the gaming site operations (for gaming

sites that were approved based on submission of a Mayor's consent with received application for no objection

by the City/Municipal Council)

Annual electronic submission of PDS through the PAGCOR Responsible Gaming website (for sole prop, partners

and each members of the BOD). Refer to PDS Application Guide of the Responsible Gaming Code of Practice.

Signature of Operator / Authorized Signatory

Name in Print

Date

Gs Form. No. 3 - Request For Renewal Of Gaming License Form Page 2