GAMING SITE Page No.

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ESTABLISHMENT Form No. GLDD-939
COMPLIANCE
Rev. No. 0
NOTIFICATION FORM
For Bingo, Electronic and Poker Games Effectivity Sept. 01, 2019
GS Form No. 32 GLDD Reference No.: _________________
Use this form to notify PAGCOR of the start and progress of setting up the Gaming Site. Please accomplish this form by
providing correct and complete information. The Operator shall submit this form to GLDD within forty five (45) days from
receipt of notice of site approval. Cut-off for submission of notifications shall be 4:00 P.M.

SECTION A: NOTIFICATION DETAILS (TO BE PROVIDED BY OPERATOR)

1. Name of Operator: ______________________________________________________________
(please provide complete registered name)
2. Gaming Site Location: ______________________________________________________________
______________________________________________________________
(as reflected in the license)
3. Gaming License Details (Gaming Activity/Game Oferring):
 Electronic Games  Bingo Games
____ eGames ____ Traditional Bingo
____ InstaWin ____ Electronic Bingo
____ MSW SportsBetting  Poker Games
Validity of Gaming License: _____________________________
4. Date of Receipt of Notice of Site Approval : ______________________________________

SECTION B: GAMING SITE ESTABLISHMENT COMPLIANCE (TO BE PROVIDED BY OPERATOR )

We confirm and undertake to comply with the following:

1. Start the construction of Gaming Site within forty five (45) days upon receipt of notice of site approval, i.e. on or
before _______________ (deadline date).
Date construction started: _______________________
2. Ensure that the Gaming Site is completely set-up and shall commence its gaming operations within one (1) year
from license issuance date.
3. Pay the Performance Cash Deposit to PAGCOR as prescribed in Section 4 under Regulation 4 of the Gaming Site
Regulatory Manuals (GSRMs).
4. Ensure that the Gaming Site is constructed in conformity with the gaming site specification guidelines as
enumerated under Regulation 7 of GSRMs.
5. Ensure the readiness of the Gaming Site to commence its gaming operation which includes, among others, the
testing on electronic gaming system/s and terminals, and network connectivity must be conducted.
6. Allow and assist PAGCOR-authorized team in the final inspection of the Gaming Site prior to its gaming operation.
7. Submit to GLDD a copy of the Business Permit issued by LGU and duly signed Acknowledgement Receipt of the
Gaming License prior to commencement of Gaming Site operation.
8. Notify GLDD of the commencement of Gaming Site at least fifteen (15) days prior to its target opening date using
the Notification of Target Opening Date (GS Form No. 5).

Printed Name: _____________________________________ Signature: _______________

(Authorized Representative)
Position Title: _____________________________________ Date: _______________

SECTION C: SUBMISSION INSTRUCTIONS

Once Sections A and B are completed, please submit/mail/e-mail this form to GLDD together with supporting
documents, if any, to the address/e-mail address indicated below:
Gaming Licensing and Development Department
Philippine Amusement and Gaming Corporation
PAGCOR Main Corporate Office, 12th Floor, iMET BPO Tower,
CBP-1A Metropolitan Park, Roxas Boulevard, Pasay City 1300
Tel. Nos. : 755-3199/755-3299/755-3899/755-3999
loc. 5012, 5013, 5014 or 5015
E-mail Address : GLDD.RGULicensing@pagcor.ph

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

 A. RETURNED due to incomplete information and/or attachment

 B. RECEIVED for PROCESSING with REFERENCE NO.: _________________
By: Printed Name: _________________________________ Signature: _____________
Position Title: _________________________________ Date: _____________