Altar tokens are rewarded to players after killing any monster in Guthix's altar, however a player does not receive the tokens on their first Guthix dragon kill, but they will receive tokens for every kill after the first. Altar tokens can be exchanged the Guthix dragon (NPC) for several rewards, but this feature isn't available till after the first guthix dragon kill, which requires level 99 in all skills. Therefore level 99 in all skills is required to exchange altar tokens.