FORM NO. 11A

ELECTRONIC GAMING MACHINE GAME CONVERSION/CHANGE IN PARAMETER SETTINGS NOTIFICATION FORM

(FOR SERVER SUPPORTED EGMs)

Use this form to notify PAGCOR regardinggame conversion or change in parameter settings ofServer SupportedElectronic Gaming Machines (EGMs) in the casino. Please accomplish this form by providing correct and complete information.The Licensee shall submit this form to the PAGCOR Monitoring Team at least thirty (30) minutes prior to start of game conversion or change in parameter settings.

PLEASE NOTE THAT PAGCOR RESERVES THE RIGHT TO CONDUCT POST-AUDIT OF THE GAME CONVERSION/CHANGE IN PARAMETER SETTINGS OF EGMsIN THE CASINO.

Licensee :
Name of Casino :
Date : / Time :
SECTION A: EGMs GAME CONVERSION/CHANGE IN PARAMETER SETTINGS
(TO BE PROVIDED BY LICENSEE)

Details of the ServerSupported EGM:

Manufacturer: ______

EGM Number
Machine Serial Number
PAGCOR Tag Number
Final Meter Reading
(prior to game conversion/change in parameter settings)

Parameter Settings of the abovementioned EGM:

FROM:

GAME THEME / APPROVED PER GLDD REF. NO. ______
NAME / DENO (P) / JACKPOT LEVEL / JACKPOTRANGE (P) / PAYOUT CONTRIBUTION / Total Jackpot RTP% / Base Game RTP% / Total Payout %
Min / Max / Start Up% / Increment%

TO:

GAME THEME / APPROVED PER GLDD REF. NO. ______
NAME / DENO (P) / JACKPOT LEVEL / JACKPOTRANGE (P) / PAYOUT CONTRIBUTION / Total Jackpot RTP% / Base Game RTP% / Total Payout %
Min / Max / Start Up% / Increment%

(Note: Please use additional sheet/s for game conversion of multiple server supported EGMs.)

REVISED 071615

We confirm and undertake to do the following:

  • The return-to-player (RTP) percentage of each EGM is within the range of ninety percent (90%) to less than ninety five percent (95%), which is the RTP percentage requirement of EGM under Regulation 4 Section 3 of the Casino Regulatory Manual.
  • The Licensee warrants that the new gameof each EGM is consistent with the game certified to have been tested by an independent gaming laboratory duly recognized by PAGCOR and passed the PAGCOR Technical Standards or any of the EGM technical standards namely, GLI-11, Macau, Singapore, Australia or any gaming jurisdiction in the United States of America.
  • Actual machine setting of each EGM shall reflect the RTP settings indicated above.
  • Any losses resulting from deviation to the above parameter settings shall be solely shouldered by the Licensee.
  • The abovementioned undertakings shall be carried out in close coordination with the Casino Compliance Monitoring and Enforcement Department and the PMT.

Printed Name : / Signature :
Position Title : / Date:

SECTION B: SUBMISSION INSTRUCTIONS

Once Section A is completed, please submit this form to the PMT. Hard copies may be submitted directly to the PMT office. If submission of this notification form is done thru e-mail, the Licensee should ensure that it has been duly received and acknowledged by PMT. The Licensee shall be notified by the PMT thru e-mail confirming receipt of this notification form. If no e-mail confirmation is received from the PMT, the Licensee should submit the notification form’s hard copy directly to the PMT.

SECTION C:ACKNOWLEDGEMENT OF NOTIFICATION(TO BE FILLED UP BY PMT)

By: / Printed Name: / Signature:
Position Title: / Date:
Time:

Upon receipt of this notification, the PMT shall furnish GLDD a copy of this Form via e-mail to the following e-mail addresses:

Gaming Licensing and Development Department

Philippine Amusement and Gaming Corporation

3rd Floor, PAGCOR House, 1330 Roxas Boulevard, Ermita, Manila

Tel. No. 254-7995 / 521-1542 loc. 206

E-mail addresses:

The PMT shall ensure that thisForm has been duly received and acknowledged by GLDD. The PMT shall be notified by GLDD thru e-mail confirming receipt of the same.

SECTION E:GLDD’S ACKNOWLEDGEMENT RECEIPT (TO BE FILLED UP BY GLDD)

RECEIVED with REFERENCE NO. ______

By: / Printed Name: / Signature:
Position Title: / Date:

REVISED 071615