GS Form No.

1A
(v.1.3) 04.17.2017

Philippine Amusement and Gaming Corporation

Gaming Licensing and Development Department
1330 PAGCOR House, Roxas Boulevard, Ermita, Manila

APPLICATION FORM FOR THE ESTABLISHMENT OF GAMING SITE

For Poker Games
PART I
GENERAL INSTRUCTIONS
1. Type or print the needed information on the spaces provided. You must provide all required information.
Otherwise, your application will be returned.
2. Refer to Annex "A" Criteria/Requirements for a Gaming Site such as distance restriction guidelines,
distance measurement and type of site location/area.
3. Email the clear scans of duly accomplished Part I form together with the prescribed documentary
requirements to:
[email protected]
4. Submission of LGU document/s is not a requirement in this Part I. Do not secure and submit LGU
document/s until you are advised by GLDD to proceed to Part II.
5. Submitted Part I shall be valid within six (6) months from the date of GLDD's advice in Item no. 4 above,
subject to Applicant's compliance with the submission of complete LGU documents and other
documentary requirements.
6. Processing of Part I shall be subject to availability of slots as determined by annual quota on
applications. Notice on opening of Part I applications shall be posted at the Electronic Gaming and Poker
page in the PAGCOR website's Regulatory link.
7. Cut-off for submission of applications shall be 4:00 P.M.
Note: For any query regarding your application, you may call tel. no. 521-1542 loc. 314 or 522-3429 or
send an email to the address above.
1 Proposed Gaming Site:

2 Name of Applicant:
(Note: If the Applicant is a corporation, partnership or other business entity, please provide full registered name.)

3 Mailing Address:

4 Telephone Number:

5 E-mail Address:

6 Tax Identification No. (TIN):

7 Name of Authorized Representative:

To be attached : 1. If Corporation - Secretary's Certificate stating Board's Resolution in designating the name of the
Authorized Representative of the company who will transact with PAGCOR and sign documents
2. If Sole Proprietorship or Partnership - Letter signed by the Applicant or Partner designating the
Authorized Representative and stating the scope of the authorization

8 Telephone Number of Authorized Representative:

9 E-mail Address of Authorized Representative:

 GS Form No. 1A
(v.1.3) 04.17.2017

SUBMITTED
INITIAL SITE REQUIREMENTS Yes No
1 Location Map of proposed site showing distances to schools,
churches or places of worship and existing / approved PAGCOR- (to be accomplished
approved gaming establishments by GLDD)

2 Please check type of establishment (as defined in Annex A - Criteria/Requirements for a Gaming Site)
Mall / Arcade
General / Commercial Building
Hotel / Resort

COMPLIANCE OF SITE TO DISTANCE RESTRICTION GUIDELINES

COMPLIANT
Name and Address of Institution / Distance Yes No
Establishment
1 Nearest School/s

2 Nearest Church/es

3 Nearest Gaming
Site/s (to be accomplished
by GLDD)

DECLARATION

By signing below, I/We declare that:

1 The information contained in this application including all documents submitted relative to this
application are valid, true and correct;

2 I/We understand that at this point, PAGCOR does not require any contractual agreement for the
proposed site. Only in the event of PAGCOR's written approval of the establishment of Gaming Site
thereat shall we execute and submit such agreement and likewise commence with the renovation of the
site. I/We will not hold PAGCOR liable for any rental/construction expenses that I/We may incur relative
thereto.

3 I/We understand that submission of LGU document/s is not a requirement in this Part I of the application,
i.e. I/we are not required to secure LGU document/s until I/we are advised by PAGCOR to proceed to
Part II.

4 I/We have executed this statement with the knowledge that misrepresentation or failure to reveal
information requested may be deemed sufficient cause for disapproval/denial of this application
or revocation of the Gaming License (GL) of Gaming Site if application has been approved by the
time such misrepresentation or act of omission is discovered.

5 I/We are certifying that the proposed site is compliant with the Local Government Unit's
requirements and regulations on the establishment and conduct of this type of operations; and that
I/We will not hold PAGCOR liable for expenses /"business losses" brought about by closure orders and/or
penalties incurred should site be found non-compliant with LGU regulations.

Name:_________________________________________ Signature: _____________________________

APPLICANT or AUTHORIZED REPRESENTATIVE

Date:
 GS Form No. 1A
(v.1.3) 04.17.2017

EVALUATION
(to be accomplished by GLDD)

Site is acceptable in terms of distance requirements and type of establishment (as declared
by Applicant); Acceptability of this site is not a guarantee of the approval of this application.
The grant of the Gaming License of a proposed site is subject to the PAGCOR Board approval.
Applicant may now proceed to Part II.
Note: Applicant should submit within 30 days from this advice the duly accomplished Part II and the
required Council Resolution, or the minimum requirements of:
(a) Letter of a Mayor's consent, with (b) copy of received application with City/Municipal Council
Failure to comply within 30 days shall mean that the next application in the area within the distance
restriction of your proposed site from another gaming site will be advised to proceed to Part II. The
first to complete requirements, first to be recommended' policy shall apply based on the date of the above
LGU documents. Submission of these LGU documents is not a guarantee of approval of the application.

Should the Applicant fail to submit the required LGU documents, the validity of submitted Part I
shall expire after six (6) months from the date of GLDD's advice to proceed to Part II.
Part I expiration date:

Application Form Part II and Application Kit

received by:
_______________________________________ _________________________________________
GLDD EVALUATOR APPLICANT or AUTHORIZED REPRESENTATIVE
Date: Date:

[nth] application in the area. This site is currently ineligible as there is a pending application
within the distance restriction of your proposed site from another gaming site. Your Part 1
application is none the less being received with this notice to you. Should the preceding
application not prosper, you will be advised to proceed to Part II.
Acknowledged by:

_______________________________________ _________________________________________
GLDD EVALUATOR APPLICANT or AUTHORIZED REPRESENTATIVE
Date: Date:

This portion to be accomplished after 30-day period given to the first applicant in the area has lapsed
Site is acceptable in terms of distance requirements and type of establishment (as declared
by Applicant); Acceptability of this site is not a guarantee of the approval of this application.
The grant of the Gaming License of a proposed site is subject to the PAGCOR Board approval.
You may now proceed to Part II.

The 'first to complete requirements, first to be recommended' policy shall apply to your application and
all other concerned applications within the area based on the date of the required LGU documents.
Submission of said LGU documents is not a guarantee of approval of the application.
Should the Applicant fail to submit the required complete LGU documents and other documentary
requirements, the validity of submitted Part I shall expire after six (6) months from the date of GLDD's
advice to proceed to Part II.
Part I expiration date:
Acknowledged by:
_______________________________________ _________________________________________
GLDD EVALUATOR APPLICANT or AUTHORIZED REPRESENTATIVE
Date: Date:

Application returned due to insufficient requirements/information

_______________________________________ _________________________________________
GLDD EVALUATOR APPLICANT or AUTHORIZED REPRESENTATIVE
Date: Date:
 GS Form No. 1A
(v.1.3) 04.17.2017

Site is unacceptable due to:

_________ Violation of distance requirement to school/s

_________ Violation of distance requirement to church/es

_________ Violation of distance requirement to PAGCOR-approved gaming establishments

_________ Not located in prescribed type of establishment

Remarks:

_______________________________________ _________________________________________
GLDD EVALUATOR APPLICANT or AUTHORIZED REPRESENTATIVE

Date: Date:

Application shall be queued. Processing of Part I applications has reached its annual quota.
Once slots are available, Part I applications shall be processed as queued and Applicant shall
accordingly be notified if its site is acceptable in terms of distance requirements and type of
establishment (as declared by Applicant).

Part I queue no. _______________

_______________________________________ _________________________________________
GLDD EVALUATOR APPLICANT or AUTHORIZED REPRESENTATIVE

Date: Date:
 GS Form No. 1A
(v.1.3) 04.17.2017

ANNEX Axxxxx
(Attachment to Application Form Part I)

Philippine Amusement and Gaming Corporation

Gaming Licensing and Development Department
1330 PAGCOR House, Roxas Boulevard, Ermita, Manila

CRITERIA/REQUIREMENTS FOR A GAMING SITE

For Poker Games
1. Not less than 200 m from schools and places of worship/churches

Schools referred herein will be the educational institutions duly registered with the Department of Education
(DepEd) and Commission on Higher Education (CHED).

The 200m distance requirement will apply to all places of worship, with the latter referring to stand-alone
place of worship holding at least 1 day of regular worship or service in a week.

The 200m distance restriction to the proposed gaming site will be waived if the proposed gaming site is
located in the same street address of an existing gaming site provided said existing gaming site has a valid
Business Permit from LGU.

2. Not less than the radial distance requirement from another PAGCOR-authorized gaming site, as
approved by the PAGCOR Board, except for the following:
When both the proposed gaming site and the other gaming site have the same street address. However, a
gaming site shall not host the same gaming activity being offered at the other gaming site.
The applicable distance restriction shall be posted at the Electronic Gaming and Poker page in the PAGCOR
website’s Regulatory link.

Note:
The distance restrictions/requirements as provided for under Item nos. 1 and 2 above shall not apply to
malls/arcades and three (3)-star hotels and resorts accredited by the Department of Tourism.

3. Measurement of Distance – in relation to items 1 and 2 above

From proposed gaming site to church and schools–radial or point to point straight distance from
property line to property line shall be used. If the proposed gaming site is inside a mall, distance shall be
measured from the exact location of the gaming site to the property line of the school/church.

From proposed gaming site to another gaming site - measured radially from property line to property line
except if gaming site is in a mall, in which case its exact location is used as reference point. Distance of
proposed poker club from another poker club shall be measured using access roads.

In measuring distance, Applicant must use either google maps or wikimapia. In measuring distance using
access roads, the vehicular odometer may be used.

4. Gaming Site Location (Type of Establishment) /Area–the following are the types of establishments and
areas where a gaming site shall be located; no stand-alone gaming site will be allowed.
a. Within malls/arcades
These are commercial buildings where majority of the located establishments provide retail sales, leisure and
entertainment to customers.

Gaming site must be within the mall’s general premises. This may include non-connected annexes that have
similar leisure and entertainment establishments as that of the mall (restaurants, etc). Typically, annex area will
belong to the same complex or share the same parking area of the mall.
 GS Form No. 1A
(v.1.3) 04.17.2017

b. General and Commercial Buildings:

Address classified by LGU Zoning Body as a commercial building.

Multi-door building where tenants provide commercial services (retail, distribution, services, banking,
food, etc).
Building should not be located beside or across informal settler dwellings.
Building will allow signage at outlet’s façade.
Mixed-use Commercial/Residential Condominium buildings are classified under this category. For these
types of buildings, the proposed gaming site must be located in the commercial area (normally the lower
floors).
Building must either have a supplied generator or allow the gaming site to have its own generator

c. Hotels / Resorts

Proposed gaming site must be located inside the building or within the same complex/premises as the Hotel /
Resort.

Proposed gaming site must be located in an identified commercial space of the hotel (as opposed to guest
rooms).

5. If there is an LGU resolution on specific guidelines on the establishment of gaming site, such guidelines must
be complied with. The Applicant’s compliance with said guidelines does not dispense with its fulfillment of
PAGCOR’s requirements stated herein.

6. Gaming Site area requirement - must accommodate a minimum of 4 poker tables