RG Form 1
Page No. Page 1 of 1
Form No. GLDD-888
EMPLOYEE VERIFICATION FORM Revision No. 1
Effectivity July 12, 2023
Use this form to request for verification of personnel employed by PAGCOR or any gaming licensees in the Philippines. Only requests with corr
complete information will be processed. Failure to provide correct and complete information may result in rejection of processing of this reques
USE BLOCK LETTERS
EMPLOYEE'S PERSONAL INFORMATION (To be filled-out by the Licensee)
Name:
Surname First M.I.
Birthdate: Sex: Male Female
mm/dd/yyyy
Verification of employee playing at: Casino Filipino/PAGCOR-operated casino e-Bingo
PAGCOR-operated arcade e-Games Station
Licensed casino Instawin outlet
Poker Club MSW outlet
Traditional Bingo
Requested by: Date:
(Signature over Printed Name)
Position: GEL No.
Licensee:
FOR GLDD USE ONLY
Licensee request is:
REJECTED for the following reasons:
Incomplete information
Others
Employee verification request yields:
No presence in GEL database
Positive presence in GEL database
Current employer:
(Licensee / Gaming Establishment)
with GEL No.
RECEIVED AND PROCESSED BY: Date:
(Signature over Printed Name)
(Position Title)
CERTIFIED BY:
GLDD Department Head
Remarks: Verification is based on name and birthdate submitted to PAGCOR GLDD. Wrong or incomplete name and birthdate may
result in mismatch with database information.
Page No. Page 1 of 1
DESIGNATED AUTHORIZED Form No. GLDD-899
SIGNATORIES Revision No. 2
Effectivity July 12, 2023
GEL FORM A
Company Letter Head:
I am submitting herewith the following information on the designated authorized signatories of our
company with their contact details:
AUTHORIZED ALTERNATE
LIAISON OFFICER
SIGNATORY LIAISON OFFICER
NAME
(Last, First Middle)
E-MAIL
OFFICE NO.
MOBILE NO.
SIGNATURE
(SPECIMEN 01)
SIGNATURE
(SPECIMEN 02)
SIGNATURE
(SPECIMEN 03)
APPROVED BY:
SIGNATURE OVER PRINTED NAME DATE
(PROPRIETOR / LICENSEE)
-------------------------------------------- FOR PAGCOR USE ONLY --------------------------------------------
RECEIVED BY: VERIFIED BY:
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
Page No. Page 1 of 1
Form No. GLDD-900
USER ACCESS CONTROL FORM Revision No. 2
Effectivity July 12, 2023
GEL FORM B
LICENSEE :
ACCESS : New REMARKS:
Delete (for PAGCOR use)
NAME :
FIRST NAME M.I. LAST NAME
EMAIL ADDRESS :
1. Access account must not be revealed to others or allowed to be used
by others.
2. Passwords must not be inserted into small messages or other forms
of electronic communication.
3. Any user found to have violated these policies may be subjected to
disciplinary action.
USER: AUTHORIZED BY:
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
(AUTHORIZED SIGNATORY)
-------------------------------------------- FOR PAGCOR USE ONLY --------------------------------------------
RECEIVED BY: VERIFIED BY:
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
APPROVED BY: ENCODED BY:
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
Page No. Page 1 of 1
Form No. GLDD-901
MASTERLIST OF POSITIONS Revision No. 2
Effectivity July 12, 2023
GEL FORM C
Company Letter Head:
Submitting herewith the list of positions with classification of our company:
POSITION TITLE CLASSIFICATION
APPROVED BY:
SIGNATURE OVER PRINTED NAME DATE
(AUTHORIZED SIGNATORY)
-------------------------------------------- FOR PAGCOR USE ONLY --------------------------------------------
RECEIVED BY: VERIFIED BY:
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
Page No. Page 1 of 1
Form No. GLDD-902
ELIGIBILITY FORM Revision No. 2
Effectivity July 12, 2023
GEL FORM D
LICENSEE :
NAME :
FIRST NAME M.I. LAST NAME
ELIGIBILITY : 1. To the best of my knowledge, I am not banned from entering any
gaming establishment in the Philippines.
2. I have not been terminated by any employer for any of the following
reasons:
2.1. Game Cheating
2.2. Fraud and/or Estafa
2.3. Theft
2.4. Forgery or Counterfeiting
2.5. Unlawful interference with a gaming equipment
2.6. Conviction of a crime involving moral turpitude
2.7. Use of camera or any electronic device to assist in projecting
the outcome of the game
2.8. Acts of dishonesty amounting to grave or serious offenses
2.9. Violation of employment contract provision/policy on prohibition
from playing in a gaming establishment
I understand that deliberately omitting information required in this form may result in the revocation of
my Gaming Employment License (GEL).
APPLICANT: NOTED BY:
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
(AUTHORIZED SIGNATORY)
Page No. Page 1 of 1
Form No. GLDD-903
ENDORSEMENT FORM Revision No. 2
Effectivity July 12, 2023
GEL FORM E
LICENSEE :
LICENSE NO. FIRST NAME MIDDLE NAME LAST NAME
This is to certify that the abovementioned names are:
• at least 21 years of age
• Former manager/executive applying for managerial/executive
positions within one (1) year from separation for a gaming employer
and certification attesting to the fact that; 1) Casino
manager/executive is not bound by any restrictive covenant or
contractual stipulation that would legally prevent him/her from
working for another casino, or 2) It is waiving the effectivity of any
such applicable restrictions
• NOT convicted by court of competent jurisdiction upon final
judgement for any crime
• NOT positive for drug use or substance abuse and is physically fit to
work
• NOT in the Terminated Employee Database (TED) and/or National
Database for Restricted Persons (NDRP)
AUTHORIZED BY:
SIGNATURE OVER PRINTED NAME DATE
(AUTHORIZED SIGNATORY)
-------------------------------------------- FOR PAGCOR USE ONLY --------------------------------------------
RECEIVED BY: VERIFIED BY:
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
APPROVED BY: ENCODED BY:
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
Page No. Page 1 of 1
NOTICE OF EMPLOYEES Form No. GLDD-904
SEPARATED FOR JUST CAUSE Revision No. 2
Effectivity July 12, 2023
GEL FORM F
LICENSEE :
DATE :
This is to certify that the employees listed below were separated from our company with due process
as prescribed by the Labor Code of the Philippines for just cause/s as specified below:
LICENSE NO. NAME CAUSE OF SEPARATION DATE OF SEPARATION
PAGCOR is hereby authorized to include the above information in the Terminated Employee Database
(TED), which may be used as reference to disqualify an applicant from endorsement of a Gaming
Employment License (GEL).
ENDORSED BY:
SIGNATURE OVER PRINTED NAME DATE
(AUTHORIZED SIGNATORY)
-------------------------------------------- FOR PAGCOR USE ONLY --------------------------------------------
RECEIVED BY: VERIFIED BY:
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
APPROVED BY: ENCODED BY:
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
Page No. Page 1 of 1
NOTICE OF EXECUTIVES/MANAGERS
Form No. GLDD-905
SEPARATED NOT GRANTED
Revision No. 2
CLEARANCE
Effectivity July 12, 2023
GEL FORM G
LICENSEE :
DATE (MM/YYYY) :
This is to certify that the executives/managers listed below were separated from our company with a
restrictive contract and will not be given clearance to work for another casino
LICENSE NO. NAME CAUSE OF SEPARATION DATE OF SEPARATION
PAGCOR is hereby authorized to include the above information in the Terminated Employee Database
(TED), which may be used as reference to disqualify an applicant from endorsement of a Gaming
Employment License (GEL).
ENDORSED BY:
SIGNATURE OVER PRINTED NAME DATE
(AUTHORIZED SIGNATORY)
-------------------------------------------- FOR PAGCOR USE ONLY --------------------------------------------
RECEIVED BY: VERIFIED BY:
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
APPROVED BY: ENCODED BY:
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
Page No. Page 1 of 1
Form No. GLDD-906
SUSPENSION/REVOCATION FORM Revision No. 2
Effectivity July 12, 2023
GEL FORM H
LICENSEE :
LICENSE NO. FIRST NAME MIDDLE NAME LAST NAME
GROUNDS : Dismissal of an employee for just causes as enumerated in Section
7.a.1 of the GEL manual
Dismissal of an employee as defined in the Labor Code of the
Philippines, as amended, or other relevant laws.
Conviction of an employee by court of competent jurisdiction upon
final judgement for any crime committed by said employee
Determination that a GEL holder/employee is positive for drug use or
substance abuse
Determination that a GEL holder/employee is not physically fit to
work
Violation of Employment Contract Provision/Policy on Prohibition
from Playing in a Gaming Establishment
Failure to obtain certification from Employer, attesting to the fact that:
1) executive/manager is not bounded by any restrictive covenant or
contractual stipulation that would legally prevent the applicant form
working for another licensee; 2) former employer is waiving the
effectivity of such restriction.
ENDORSED BY:
SIGNATURE OVER PRINTED NAME DATE
(AUTHORIZED SIGNATORY)
-------------------------------------------- FOR PAGCOR USE ONLY --------------------------------------------
PENALTY : Suspension
Revocation
FINDINGS : Approved EFFECTIVITY DATE:
Denied
RECEIVED BY: VERIFIED BY:
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
APPROVED BY: ENCODED BY:
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
Page No. Page 1 of 1
Form No. GLDD-907
PERSONNEL COUNT REPORT Revision No. 2
Effectivity July 12, 2023
GEL FORM I
COVERING PERIOD:
LICENSEE:
SITE ADDRESS:
DETAILS
GEL NUMBER NAME REMARKS
DATE HIRED CLASSIFICATION POSITION TITLE
* use another sheet if needed
PREPARED BY:
SIGNATURE OVER PRINTED NAME DATE
(AUTHORIZED SIGNATORY)
-------------------------------------------- FOR PAGCOR USE ONLY --------------------------------------------
RECEIVED BY: VERIFIED BY:
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
Page No. Page 1 of 1
TEMPORARY GAMING Form No. GLDD-908
EMPLOYMENT LICENSE PERMIT Revision No. 2
Effectivity July 12, 2023
GEL FORM J
LICENSEE :
FIRST NAME MIDDLE NAME LASTNAME REMARKS
NAME OF EVENT :
VENUE :
DURATION : From: To:
(note that duration must not exceed 30 days)
This is to certify that the abovementioned names are:
• at least 21 years of age
• NOT GEL holders
• NOT convicted by court of competent jurisdiction upon final
judgement for any crime
• NOT positive for drug use or substance abuse and is physically fit to
work
• NOT in the Terminated Employee Database (TED) and/or National
Database for Restricted Persons (NDRP)
We are responsible and accountable for the actions of the person above
for the duration of the event
AUTHORIZED BY:
SIGNATURE OVER PRINTED NAME DATE
(AUTHORIZED SIGNATORY)
-------------------------------------------- FOR PAGCOR USE ONLY --------------------------------------------
RECEIVED BY: VERIFIED BY:
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
APPROVED BY: ENCODED BY:
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
Page No. Page 1 of 1
TEMPORARY GAMING Form No. GLDD-908
EMPLOYMENT LICENSE PERMIT Revision No. 2
Effectivity 07/12/2023
Page No. Page 1 of 1
Form No. GLDD-909
REINSTATEMENT FORM Revision No. 3
Effectivity July 12, 2023
GEL FORM K
LICENSEE :
LICENSE NO :
NAME :
FIRST NAME M.I. LAST NAME
REASON FOR :
REINSTATEMENT
This is to certify that the above employee has satisfied the conditions for
the reinstatement of his/her GEL.
ENDORSED BY:
SIGNATURE OVER PRINTED NAME DATE
(AUTHORIZED SIGNATORY)
-------------------------------------------- FOR PAGCOR USE ONLY --------------------------------------------
FINDINGS : Approved EFFECTIVITY DATE:
Denied
RECEIVED BY: VERIFIED BY:
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
APPROVED BY: ENCODED BY:
SIGNATURE OVER PRINTED NAME DATE SIGNATURE OVER PRINTED NAME DATE
