A total of ten teams, the 2nd to 10th ranked losing teams from the first round and the Northern Mariana Islands, will play home-and-away over two legs that determine the final five qualifiers. The play-off winners join the 19 teams which advance directly to the third round (one best ranked losing team from the first round and 18 teams from the second round) to compete for the final 6 slots in the 2027 AFC Asian Cup.
The draw for the play-off round will be held on 9 May 2024 in Kuala Lumpur, Malaysia.[2] In the same press release, Guam and Northern Mariana Islands had both withdrawn plus, as a knock-on effect, Maldives and Laos were exempt and given a bye to the next round.
These 6 teams were divided into three pairings, with each pair playing home and away across 5 and 10 September 2024. The numbers in parentheses indicate the FIFA Men's World Ranking of April 2024.