Fillable Fincen Form 103 - Multiple Persons Or Multiple Agents

FinCEN Form 103 (Rev. 3-03) (Formerly Form 8362)

Page

Multiple Persons or Multiple Agents

(Complete applicable parts below if box 2 or box 16 on page 1 is checked.)

Person(s) Involved in Transaction(s)

Part I

Section A--Person(s) on Whose Behalf Transaction(s) Is Conducted (Customer)

Multiple persons

4 First name

5 M.I.

3 Individual’s last name or Organization’s name

6 Permanent address (number, street, and apt. or suite no.)

7 SSN or EIN

10 ZIP code

11 Country (if not U.S.)

12 Date of birth

8 City

9 State

____/____/________

M M

D D

Y Y Y Y

13 Method used to verify identify:

Examined identification credential/document

Known Customer - information on file

Organization

14 Describe identification credential: a

Driver’s license/State ID b

Passport

Alien registration

Other

e Issued by:

Number:

15 Customer’s Account Number

Section B--Individual(s) Conducting Transaction(s) - If other than above (Agent)

Multiple persons

17 Individual’s last name

18 First name

19 M.I.

20 Address (number, street, and apt. or suite no.)

21 SSN

22 City

23 State

24 ZIP code

25 Country (if not U.S.)

26 Date of birth

____/____/________

M M

D D

Y Y Y Y

27 Method used to verify identify:

Examined identification credential/document

Known Customer - information on file

Organization

28 Describe identification credential: a

Driver’s license/State ID b

Passport

Alien registration

Other

e Issued by:

Number:

General Instructions

clubs are subject to the same reporting rules as

Acceptable forms of identification include a driver’s

casinos, the term “casino” as used in these instructions

license, military or military dependent identification

card, passport, alien registration card, state issued

refers to both a casino and a card club.

Form 103. Use this revision of Form 103 (formerly

identification card, cedular card (foreign), or a

8362) for filing on reportable transactions.

Note: Nevada casinos must file Form 8852, Currency

combination of other documents that contain an

However, the July 1997 version of Form 8362,

Transaction Report by Casinos - Nevada (CTRC-N),

individual’s name and address and preferably a

Currency Transaction Report by Casinos (also

to report transactions as required under Nevada

photograph and are normally acceptable by financial

referred to as a CTRC), can still be used until

Regulation 6A.

institutions as a means of identification when cashing

September 30, 2003.

checks for persons other than established customers.

What to file. A casino must file Form 103 for each

For casino customers granted accounts for credit,

Suspicious Transactions. If a transaction is greater

deposit, or check cashing, or on whom a CTRC

transaction involving either currency received (Cash

than $10,000 in currency as well as suspicious,

containing verified identity has been filed, acceptable

In) or currency disbursed (Cash Out) of more than

casinos must file a Form 103 and must report

$10,000 in a gaming day. A gaming day is the normal

identification information obtained previously and

suspicious transactions and activities on FinCEN

business day of the casino by which it keeps its books

maintained in the casino’s internal records may be

Form 102, Suspicious Activity Report by Casinos

and records for business, accounting , and tax

used as long as the following conditions are met. The

(SARC). Also, casinos are required to use the SARC

purposes. Multiple transactions must be treated as a

customer’s identity is re-verified periodically, any out-

form to report suspicious activities involving or

single transaction if the casino has knowledge that:

of-date identifying information is updated in the

aggregating at least $5,000 in funds. Do not use

(a) they are made by or on behalf of the same person,

internal records, and the date of each re-verification

Form 103 to (a) report suspicious transactions

is noted on the internal record. For example, if

and (b) they result in either Cash In or Cash Out by

involving $10,000 or less in currency or (b)

documents verifying an individual’s identity were

the casino totaling more than $10,000 during any

indicate that a transaction of more than $10,000

one gaming day. Reportable transactions may occur

examined and recorded on a signature card when a

is suspicious.

at a casino cage, gaming table, and/or slot machine.

deposit or credit account was opened, the casino may

When a suspicious activity requires immediate

The casino should report both Cash In and Cash Out

rely on that information as long as it is re-verified

attention, casinos should call 1-800-800-2877,

transactions by or on behalf of the same customer

periodically.

Monday through Friday, from 9:00a.m. to

on a single Form 103. Do not use Form 103 to report

6:00p.m. Eastern Standard Time (EST). An Internal

receipts of currency in excess of $10,000 by non-

When and where to file: File each Form 103 by the

Revenue Service (IRS) employee will direct the

15th calendar day after the day of the transaction with

gaming businesses of a casino (e.g., a hotel); instead,

call to the local office of the IRS Criminal

the:

use Form 8300, Report of Cash Payments Over

Investigation (CI). In an emergency, consult

$10,000 Received in a Trade or Business.

IRS Detroit Computing Center

directory assistance for the local IRS CID office.

ATTN: CTRC

Exceptions. A casino does not have to report

P .O. Box 32621

Who must file. Any organization duly licensed

transactions with domestic banks, currency dealers

Detroit, MI 48232

or authorized to do business as a casino, gambling

or exchangers, or commercial check cashers.

casino, or card club in the United States (except

A casino must retain a copy of each Form 103 filed

casinos located in Nevada) and having gross

for 5 years from the date of filing.

Identification requirements. All individuals (except

annual gaming revenues in excess of $1 million

employees conducting transactions on behalf of

must file Form 103. This includes the principal

armored car services) conducting a reportable

Penalties. Civil and/or criminal penalties may be

headquarters and every domestic branch or place

transaction(s) for themselves or for another person

assessed for failure to file a CTRC or supply

of business of the casino or card club. The

must be identified by means of an official or otherwise

information, or for filing a false or fraudulent CTRC.

requirement includes state-licensed casinos (both

reliable record.

See 31 U.S.C. 5321, 5322, and 5324.

land-based and riverboat), tribal casinos, and

state-licensed and tribal card clubs. Since card

Fincen Form 103 - Multiple Persons Or Multiple Agents - 2003

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