Fincen Form 103 - Multiple Persons Or Multiple Agents - 2011
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FinCEN Form 103 (03-1 1)
Page
Multiple Persons or Multiple Agents
(Complete applicable parts below if box 2 or box 17 on page 1 is checked.)
Person(s) Involved in Transaction(s)
Part I
Section A--Person(s) on Whose Behalf T ransaction(s) Is Conducted (Customer)
*3 Individual’s last name or Organization’s name
*4 First name
5 M.I.
6 Doing business as (DBA)
*7 Permanent address (number, street, and apt. or suite no.)
*8 SSN or EIN
*9 City
*10 State *11 ZIP code
*12 Country (if not U.S.)
*13 Date of birth
___/___/____
M M
D D
Y Y Y Y
*14 Method used to verify identity:
a
Examined identification credential/document
b
Known Customer - information on file
c
Organization
*15 Describe identification credential: a
Driver’s license/State ID
b
Passport
c
Alien registration
z
Other
Issued by:
Number:
16 Customer’s Account Number
Section B--Individual(s) Conducting Transaction(s) - If other than above (Agent)
18 Individual’s last name
19 First name
20 M.I.
21 Address (number, street, and apt. or suite no.)
22 SSN
23 City
24 State
25 ZIP code
26 Country (if not U.S.)
27 Date of birth
___/___/____
M M
D D
Y Y Y Y
28 Method used to verify identity:
a
Examined identification credential/document
b
Known Customer - information on file
29 Describe identification credential:
a
Driver’s license/State ID b
Passport
c
Alien registration
z
Other
Issued by:
Number:
General Instructions
received (Cash In) or currency disbursed (Cash Out)
departing, the increase in the amount of the
of more than $10,000 in a gaming day. A gaming
currency bet would represent a new bet of currency
day is the normal business day of the casino by
and a transaction in currency) or ,
Form 103. Use this revision of Form 103 for filing on
which it keeps its books and records for business,
Jackpots from slot machines or video lottery
reportable transactions.
•
accounting, and tax purposes. Multiple
terminals.
transactions must be treated as a single transaction
Suspicious Transactions. If a transaction is greater
if the casino has knowledge that: (a) they are made
Identification requirements. All individuals (except
than $10,000 in currency as well as suspicious, casinos
by or on behalf of the same person, and (b) they
employees conducting transactions on behalf of armored
must file a Form 103 and must report suspicious
result in either Cash In or Cash Out by the casino
transactions and activities on FinCEN Form 102 ,
car services) conducting a reportable transaction(s) for
totaling more than $10,000 during any one gaming day .
Suspicious Activity Report by Casinos (SARC). Also,
themselves or for another person must be identified by
Reportable transactions may occur at a casino cage,
means of an official or otherwise reliable record.
casinos are required to use the SARC form to report
gaming table, and/or slot machine/video lottery terminal.
Acceptable forms of identification include a driver’s
suspicious activities involving or aggregating at least
The casino should report both Cash In and Cash Out
license, military or military dependent identification card,
$5,000 in funds. Do not use Form 103 to (a) report
transactions by or on behalf of the same customer on a
passport, alien registration card, state issued identification
suspicious transactions involving $10,000 or less in
single Form 103. Do not use Form 103 to report receipts
card, cedular card (foreign), or a combination of other
currency or (b) indicate that a transaction of more
of currency in excess of $10,000 by non-gaming
unexpired documents that contain an individual’s name
than $10,000 is suspicious.
businesses of a casino ( e.g., a hotel); instead, use
In situations involving suspicious transactions
and address and preferably a photograph and are
Form 8300, Report of Cash Payments Over
normally acceptable by financial institutions as a means
requiring immediate attention, such as when a
$10,000 Received in a Trade or Business.
of identification when cashing checks for persons other
reportable transaction is ongoing, the casino or
than established customers.
card club shall immediately notify , by telephone,
Exceptions. A casino does not have to report
For casino customers granted accounts for credit,
appropriate law enforcement and regulatory
transactions with:
deposit, or check cashing, or on whom a CTRC cont aining
authorities in addition to filing a timely
domestic banks; or
verified identity has been filed, acceptable identification
•
suspicious activity report.
currency dealers or exchangers, or check cashers,
information obtained previously and maintained in the
•
casino’s internal records may be used as long as the
as defined in 31 C.F .R. § 1010.100(f f), and which
Who must file. Any organization duly licensed or
following conditions are met. The customer’s identity is
are conducted pursuant to a contractual or other
authorized to do business as a casino, gambling
reverified periodically, any out-of-date identifying
agreement covering the financial services in 31
casino, or card club in the United States and having
information is updated in the internal records, and the
C . F. R . 1 0 2 1 . 3 1 1 ( a ) ( 8 ) , 1 0 2 1 . 3 1 1 ( b ) ( 7 ) ,
gross annual gaming revenues in excess of $1 million
date of each reverification is noted on the internal record.
and1021.311(b)(8).
must file Form 103. This includes the principal
For example, if documents verifying an individual’s
Also, a casino does not have to report the following
headquarters and every domestic branch or place
identity were examined and recorded on a signature
types of transactions:
of business of the casino or card club. The
card when a deposit or credit account was opened, the
Cash ins when it is the same physical currency
•
requirement includes state-licensed casinos (both
casino may rely on that information as long as it is
previously wagered in a money play on the same table
land-based and riverboat), tribal casinos, and state-
reverified periodically.
game without leaving the table;
licensed and tribal card clubs. Since card clubs are
Bills inserted into electronic gaming devices in
•
subject to the same reporting rules as casinos, the
When and where to file: This form can be e-filed
multiple transactions (unless a casino has
term “casino” as used in these instructions refers to
through the Bank Secrecy Act E-filing System.
knowledge pursuant to 31 C.F .R. 1021.313);
both a casino and a card club.
Go to to register .
Cash outs won in a money play when it is the
•
This form is also available for download on the Web
same physical currency wagered, ( Note: However,
What to file. A casino must file Form 103 for
at , or may be ordered by calling the
when a customer increases a subsequent cash bet
each transaction involving either currency
IRS Forms Distribution Center at (800) 829-3676.
(i.e., money play), at the same table game without
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