Form 107 - Registration Of Money Services Business Instructions (Page 3 of 3) in pdf

FinCEN Form 107

Registration of Money Services Business Instructions

Items 32 to 35-- Enter the permanent address

criminal penalties,

which may

include

one) as appropriate, and do not check any

for the financial institution.

imprisonment for up to five (5) years and criminal

individual state or territory boxes. If box a, b, or c

fines. See 18 USC 1960. Note: This registration

does not apply, check as many state or territory

Item 36--Primary transaction account number .

does not satisfy any state or local licensing or

boxes as necessary . If a service is of fered on

Enter the primary transaction account number .

registration requirement s.

tribal lands, mark the box for the state, territory

or district in which the tribal lands are located.

Part VI Location of Supporting

Paperwork Reduction Act Notice.

Documentation

The purposes of this form are to provide an effec-

Item 25--Enter the number of branches of the

tive and consistent means for money services busi-

registrant. Enter the number of branches of the

nesses to register with the Financial Crimes En-

General: The registrant must retain for five (5)

money services business at which one or more

forcement Network, and to assure maintenance of

years certain information at a location within the

MSB activities are offered. If there are no branches,

reports or records where such reports or records

United States. That information includes:

enter zero. See the General Information for an

have a high degree of usefulness in criminal, tax,

1. A copy of the registration form.

explanation of the term “branch”.

or regulatory investigations or proceedings. This

2. Annual estimate of the volume of the registrant’s

report is required by law , pursuant to authority

business in the coming year .

Item 26--MSB activities of the registrant. Items

contained in Public Law 103-305; 31 USC 5330; 5

3. The following information regarding ownership

25a through 2 5i are MSB activities. Check t he

USC 301; 31 CFR Chapter X. The information

or control of the business: the name and address

box of each MSB activity conducted b y t he

collected may be provided to those officers and

of any shareholder holding more than 5% of the

registrant at its branches.

See the General

employees of any constituent unit of the Depart-

registrant’s stock, any general p artner, any trustee,

Information for an explanation of the terms “issuer”,

ment of the Treasury who have a need for the

and/or any director or officer of the business.

“seller”, “redeemer”, “check casher”, and “money

records in the performance of their duties. The

4. An agent list.

transmitter”.

records may be referred to any other depart-

If the registrant has agents it must prepare and

ment or agency of the United S tates, to any State,

maintain a list of its agents. That agent list must be

Item 27--Informal value transfer system. If any

or Tribal Government. Public reporting and re-

updated annually and retained by the business at

part of the registrant’s money services business is an

cordkeeping burden for this information collec-

the location in the United States reported on this

informal value transfer system, check yes. An

tion is estimated to average 30 minutes per re-

registration form in Part II or Part VI. The agent list

informal value transfer system is a kind of money

sponse, and includes time to gather and maintain

should not be filed with this registration form.

data for the required report, review the instruc-

transmitter. See the General Information

tions, and complete the information collection.

The agent list must include:

explanation of the term “money transmitter”.

Send comments regarding this burden estimate,

a. Each agent’s name,

including suggestions for reducing the burden,

b. Each agent’s address,

Item 28 --Mobile o peration. If any part of the

to the Office of Management and Budget Paper-

c. Each agent’s telephone number,

registrant’s money services business is conducted

work Reduction Project, Washington, DC 20503

d. The type of service(s) provided by each agent on

as a mobile operation, check yes. A mobile

and to the Paperwork Reduction Act; Department

behalf of the registrant,

operation is one based in a vehicle. For example,

of the Treasury, Financial Crimes Enforcement

e. A listing of the months in the immediately

a check cashing service offered from a truck is a

Network, P.O. Box 39 , V ienna, VA 22183-0039.

preceding 12 months in which the gross transaction

mobile operation. For purposes of Item 25, each

The agency may not conduct or sponsor , and an

amount of each agent with respect to financial products/

mobile operation should be counted as a separate

organization (or a person) is not required to re-

services issued by the registrant exceeds $100,000,

branch.

spond to, a collection of information unless it dis-

f. The name and add ress of any depository

plays a currently valid OMB control number .

institution at which each agent maintains a transaction

Item 29--Number of agents. Enter the number of

Privary Act Notice.

account for the money services business activities

agents that the registrant has authorized to sell or

Pursuant to the requirements of Public Law 93-

conducted by the agent on behalf of the registrant,

distribute its MSB services. Do not count branches

579 (Privacy Act of 1974), notice is hereby given

g. The year in which each agent first became an

or any person who is solely an employee of the

that, in accordance with 5 U.S.C. 552a(e), the au-

agent of the registrant, and

MSB. A bank is not an agent for this purpose. See

thority to collect information on FinCEN Form 107

h. The number of branches or subagents of each

the General Information for an explanation of the

is Public Law 103-305; 31 USC 5330; 5 USC 301;

agent.

term “agent”.

31 CFR Chapter X. The Department of the Trea-

sury may use and share the information with any

Part V Primary T ransaction Account for

Items 37 to 40--If the supporting documentation

other department or agency of the United States,

MSB Activities

is retained at a location other than the address

to any State, or Tribal Government, or part thereof,

listed in Part II, enter the location information in

upon the request of the head of such department

or agency, or authorized S tate or Tribal Govern-

items 37 through 40.

Item 30--Check the box if the registrant has more

ment official for use in a criminal, tax, or regula-

than one primary transaction account for money

Part VII Authorized Signature

tory investigation or proceeding, and to foreign

services business activities. Example: If the

governments in accordance with an agreement, or

registrant is both an issuer of money orders and an

a treaty.

Items 41 to 44--The owner or controlling person

issuer of traveler’s checks and the registrant has

Disclosure of this information is mandatory. Civil

listed in Part III must sign and date the form as

separate clearing accounts for money orders and

and criminal penalties, including in certain cir-

indicated in Part VII. If the owner or controlling

traveler’s checks, the box should be checked.

cumstances a fine of not more than $5,000 per

person is a corporation, a duly authorized officer

Item 31--Name of the financial institution where

day and imprisonment of not more than five years,

of the corporation must execute the form on behalf

the primary transaction account is held. Enter

are provided for failure to file the form, supply

of the corporation. Enter the date this document

the name of the bank or other

financial institution

information requested by the form, and for filing a

was signed.

where the registrant has its primary transaction

false or fraudulent form. Disclosure of the social

account. I f you indicated that the registrant has

security number or taxpayer identification number

Penalties for failure to comply: Any person who

more than one primary transaction account in Item

is mandatory. The authority to collect is 31 CFR

fails to comply with the requirements to register,

30, enter information about the account with the

Chapter X. The social security number/taxpayer

keep records, and/or maintain agent lists

greatest money service activity transaction volume

identification number will be used as a means to

pursuant to 31 CFR 10 22.380 may be liable for

as measured by value in dollars. See the General

identify the individual or entity who files the re-

civil penalties of up to $5,000 for each violation.

Information for an explanation of the term

port.

Failure to comply also may subject a person to

“transaction account”.

Form 107 - Registration Of Money Services Business Instructions Page 3

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