Note: Use a separate application form for Lotto. It is required when you apply for Keno.

REPUBLIKA NG PILIPINAS
(Republic of the Philippines)
TANGGAPAN NG PANGULO
(Office of the President)
TANGGAPAN NG SWEEPSTAKES PANGKAWANGGAWA NG PILIPINAS
PHILIPPINE CHARITY SWEEPSTAKES OFFICE
PCSO, Sun Plaza Bldg. 1507 Princeton St. Corner Shaw Blvd, Mandaluyong City 1552

ON-LINE KENO AGENT APPLICATION INFORMATION

A. Application:
This application form is free. It can be obtained either from PCSO Main Office, all PCSO Provincial Branch Offices situated around the country.
B. Applicant must be:
For Natural Person (Individual Applicant):
1. Filipino Citizen; and
2. At least 21 years old
For Juridical Person (Corporation)
1. It must be duly registered and existing under Philippines laws
2. It must be 100% Filipino-owned
C. The proposed site must meet the following distance requirements: (Note: The distance is to be measured from the door of the
establishment proper to the proposed outlet and shall follow road directions and not the straight line or hypotenuse distance between the
two points)
Establishments / Structures Distance Restriction from the Proposed Keno Outlet
50 meters
A. Existing Keno Outlet/s
(minimum distance only)
B. School
1. Elementary Schools 100 meters
2. Secondary Schools 100 meters

D. Keno Booth Requirements

1. Floor space is at least 2m x 2m. Business counters measuring at least 36” x 24”.
2. Dry floor space with proper ventilation.
3. With at least one (1) wireless or fixed landline telephone facility for hotline operation use.
4. For security reasons, all Keno outlets should be enclosed and must be facing the direction of human traffic/entry. Frontage must
face the main hallway/corridor or to the direction of major traffic flow.
5. Outlets located within a commercial building or complexes, with 24-hours security, keno booths need not be enclosed.
6. Other technical requirements:
6.1. One (1) set of Personal Computer with a minimum 21-inch colored LED/LCD monitor to display drawing of on-line Keno
winning numbers.

E. Keno Outlet Application Documentary Requirements

1. Fill-up Application Form and attach the following documentary requirements:

NATURAL PERSON (INDIVIDUAL APPLICANT) JURIDICAL PERSON (CORPORATION)

a) Birth Certificate of Applicant
b) Three (3) latest ID pictures (2x2) of applicant and a) Biodata of Officers and Directors
spouse, if applicable b) Certified True Copy of S.E.C Registration, Articles of
c) Proof of Identification: (any two valid ID) Incorporation, and By-Laws
d) Proof of Income: c) Secretary Certificate and or Board Resolution duly
Employed: authorizing person/s to transact with PCSO for purpose
1.) Income Tax Return of the operating a Keno outlet
2.) Certificate of Employment 1. Three (3) latest ID pictures (2x2) of the authorized
Self-Employed: representative
1.) Income Tax Return 2. Proof of Identification (any two (2) valid ID)
2.) Registration of Business (for existing business) 3. Latest and Original NBI Clearance
3.) Audited Financial Statement (if applicable) d) Latest Audited Financial Statement
e) NBI Clearance (Current) e) I.T.R. for the immediate preceding year
f) Barangay Clearance (Personal Record)

2. Sketch/Location Map of the proposed site showing location/s of existing Keno outlet/s in the area
3. Pictures/photos of the proposed outlet/site including its vicinity.
4. Proof of Ownership/Lease of Outlet
For Owner:
 Land Title or TCT
For Lessee:
 Authority/Certification from Building Owner (notarized)
5. For applicants that own existing Lotto outlet(s), only an Application Form and payment of application fee shall be required
for submission to PCSO.

F. Keno Application Procedure/s:

1. Submit duly accomplished Keno Application Form set and COMPLETE DOCUMENTARY REQUIREMENTS to PCSO.
1.1 For outlets within Metro Manila at the PCSO Main Office, Technical Evaluation & Monitoring Division.
1.2 For outlets outside Metro Manila, at the PCSO Branch Office covering the location
2. Pay the required fee of P2,500.00 to the PCSO Treasury Department (Main Office) or Cashier (Branch Office)
3. Within 30 days from notice of approval:
3.1 Pay the Installation fee of P10,000.00 to the PCSO Treasury Department (Main Office) or Cashier (Branch Office).
3.2 Post a Cash Bond of P300,000.00. In lieu of a cash bond, Surety Bond to cover the amount of P700,000.00 can be submitted.
3.3 Operate the outlet.
 REPUBLIKA NG PILIPINAS
(Republic of the Philippines)
TANGGAPAN NG PANGULO
(Office of the President)
TANGGAPAN NG SWEEPSTAKES PANGKAWANGGAWA NG PILIPINAS
PHILIPPINE CHARITY SWEEPSTAKES OFFICE
PCSO, Sun Plaza Bldg. 1507 Princeton St. Corner Shaw Blvd, Mandaluyong City 1552

ON-LINE KENO AGENT APPLICATION

Date: _____________________________

Hon. Jose Ferdinand Rojas II

General Manager
PCSO, Sun Plaza Bldg. 1507 Princeton St. Corner Shaw Blvd, Mandaluyong City 1552

Dear Sir:

This is to signify my intention to apply as Keno Agent of the Philippine Charity Sweepstakes Office in the Province / Municipality / City of
___________________________

Specific Address of Proposed Outlet Site:

______________________________________________________________________
______________________________________________________________________

As an applicant I hereby:

1. Affirm that:
1.1 I have read, understood and accept the criteria, procedure, requirements and the information for this application; and
1.2 All the information given in this application is true and correct with my own personal knowledge.

2. I understand, acknowledge and accept that:

2.1 The discovery of any falsehood in the information given or non-compliance with the stated procedures shall result in the
outright denial of the application or, if already granted the revocation thereof;
2.2 The approval of this application is purely discretionary on the part of PCSO.

Thank you.

Very truly yours,

_____________________________
Signature over printed Name

SKETCH/LOCATION MAP OF THE

PROPOSED AGENCY SITE

Please indicate Main Streets, Side Streets and Landmarks.

(Ilagay ang Main Streets, Side Streets at ang mga pook palatandaan)
 REPUBLIKA NG PILIPINAS
(Republic of the Philippines)
TANGGAPAN NG PANGULO
(Office of the President)
TANGGAPAN NG SWEEPSTAKES PANGKAWANGGAWA NG PILIPINAS
PHILIPPINE CHARITY SWEEPSTAKES OFFICE
PCSO, Sun Plaza Bldg. 1507 Princeton St. Corner Shaw Blvd, Mandaluyong City 1552

APPLICANT INFORMATION SHEET

APPLICANT’S NAME (Last Name, First Name, Middle Name/Business Name/Company Name

Home Address Contact Details

Landline -
Mobile -
Email -
Date of Birth (mm/dd/yy) Age Height (feet’inches) Weight (kgs) Place of Birth

Gender Civil Status Nationality

Male Female Single Married Others, specify

Spouse Name Occupation

Date of Birth School/Company

Name of Children
(mm/dd/yyyy) (if applicable)
/ /
/ /
/ /
PLEASE USE SEPARATE SHEET IF NECESSARY

Educational Background
Inclusive Dates of
Year
Level Name of School Degree Course Attendance (From-
Graduated
To)
Elementary
High School
Vocational/ Trade
Course
College
Graduate Studies
PLEASE USE SEPARATE SHEET IF NECESSARY

Employment/Business Experience (from current to past – 10 years)

Private Government Casual/ Permanent/ Project Part-time Retired Unemployed
Sector Contractual Regular Based
INCLUSIVE
Business Address and Private/Government
DATES Position/Title Department/Agency/Office/Company Salary
Contact Numbers /Kind of Business
(From – To)

PLEASE USE SEPARATE SHEET IF NECESSARY

 Assets and Liabilities
ASSETS LIABILITIES
Cash on Hand/In
Php Accounts Payable Php
Banks
Inventory Misc Accruals
Accounts Receivable Loans Payable
Investments Other Liabilities
Fixed Assets Total Liabilities
Other Assets Net Worth
TOTAL LIABILITIES & NET
TOTAL ASSETS Php Php
WORTH
PLEASE USE SEPARATE SHEET IF NECESSARY

Are you related by consanguinity or affinity to any PCSO If YES, give details:
Officials/Employees? Yes

No
Do you have any interest in a corporation that owns and operates If YES, give details:
Lotto/Keno outlets? Yes

No
Do you have any relative (by consanguinity or affinity) owning/ If YES, give details: (please use separate sheet)
operating an existing Lotto/Keno outlet? Yes Relationship:
How many outlets:
No Location(s):
Do you have existing Lotto/Keno outlet/s? If YES, how many? ______
Yes Location(s):

No
Have you ever been formally charged? Have you ever been If YES, give details:
convicted? Status? Yes

No

References (person not related by consanguinity or affinity)

Name Address Contact Number

Date Accomplished Signature

ID picture taken within the

last six months
(2x2)

Computer generated or Xerox

copy of picture is not accepted RIGHT
THUMBMARK