Fillable Fincen Form 103 - Multiple Persons Or Multiple Agents

FinCEN Form 103 (Rev. 3-03)

Page 3

Definitions. For purposes of Form 103, the terms

the transaction is conducted on behalf of an

Item 15. Customer account number.—Enter the

below have the following meanings:

organization, enter the name in Item 3 and leave Items

account number which corresponds to the transaction

4 and 5 BLANK, but identify the individual conducting

being reported and which the casino has assigned to

Agent. Any individual who conducts a currency

the transaction in Section B. If an organization has a

the person whose name is entered in Item 3. If the

transaction on behalf of another individual or

separate “doing business as (DBA)” name, enter in

person has more than one account number affected

organization.

Item 3 the organization’s legal name (e.g., Smith

by the transaction, enter the account number that

Enterprises, Inc.) followed by the name of the business

corresponds to the majority of currency being

Currency. The coin and paper money of the United

(e.g., DBA Smith Casino Tours). In this case, use Items

reported.

States or of any other country that is circulated and

4 and 5 if more space is needed.

customarily used and accepted as money.

Items 6, 8, 9, 10, and 11. Address.—Enter the

If the transaction does not involve an account number,

Customer. Any person involved in a currency

permanent street address, city, two-letter state

enter “NOT APPLICABLE” in the space.

transaction whether or not that person participates in

abbreviation used by the U.S. Postal Service, and ZIP

the casino’s gaming activities

code of the person identified in Item 3. Also, enter in

Section B. Individual(s) Conducting

Item 6 the apartment or suite number and road or

Transaction(s) – If Other Than Above (Agent)

Person. An individual, corporation, partnership,

route number. Do not enter a P . O. box number unless

Complete Section B if an individual conducts a

trust or estate, joint stock company, association,

the person has no street address. If the person is from

transaction on behalf of another person(s) listed in

syndicate, joint venture, or any other

a foreign country, enter any province name as well as

Section A. If an individual conducts a transaction on

unincorporated organization or group.

the appropriate two-letter country code (e.g., “CA”

his/her own behalf, leave Section B BLANK.

for Canada, “JA” for Japan, etc.). If the country is the

Organization. Person other than an individual.

United States, leave Item 11 BLANK.

Item 16. Multiple agents.—If, during a gaming day,

more than one individual conducts transactions on

Transaction In Currency (Currency Transaction).

Item 7. Social security number (SSN) or

behalf of an individual or organization listed in Section

The physical transfer of currency from one person to

Employer identification number (EIN).—

A, check this box and complete Section B. List one of

another.

Enter the SSN (if an individual) or EIN (if other than

the individuals on the front of the form and the other

an individual) of the person identified in Items 3

individual(s) on page 2, Section B. Attach additional

Negotiable Instruments. All checks and drafts

through 5. If that individual is a nonresident alien

sheets as necessary.

(including business, personal, bank, cashier’s, and

individual who does not have an SSN, enter “NONE”

third-party), traveler’s checks, money orders, and

in this space.

Items 17, 18, and 19. Name of individual.— Enter

promissory notes, whether or not they are in bearer

the individual’s last name in Item 17, first name in

form.

Item 12. Date of birth.—Enter the customer’s date

Item 18, and middle initial in Item 19. If there is no

of birth (DOB) if it is known to the casino through an

middle initial, leave Item 19 BLANK. For example, if

Specific Instructions

existing internal record or reflected on an appropriate

John Doe, an employee of the Error Free Rock Band,

identification document or credential presented to

cashes an $11,000 check for the band, Error Free Rock

the casino to verify the customer’s identity (see

Band is identified in Section A, and John Doe is

Note: Additional information that cannot fit on the

Identification Requirements above). Internal casino

identified in Section B.

front and back of Form 103 must be submitted on

records can include those for casino customers granted

plain paper attached to Form 103. Type or print the

accounts for credit, deposit, or check cashing, or on

individual’s or organization’s name and identifying

Items 20, 22, 23, 24, and 25. Address.— Enter the

whom a CTRC containing verified identity has been

number, date of transaction, and casino’s name and

permanent street address, including ZIP code, of the

filed. If such records do not indicate the DOB, a casino

individual conducting the transaction. If the individual

employer identification number (i.e., Items 3, 4, 5, 7,

should ask the customer for the DOB. If the DOB is

is from a foreign country, enter any province name

32, 34, 35, and 36) as well as identify the specific

not available from any of these sources, the casino

and the appropriate two-letter country code.

item number on all additional sheets. This will ensure

should enter NOT AVAILABLE in the space. Eight

that if a sheet becomes separated, it will be associated

numerals must be inserted for each date. Enter the

with the appropriate Form 103.

Item 21. Social security number (SSN).—

date in the format “mmddyyyy”, where “mm” is the

Enter the SSN of the individual identified in Items 17

month, “dd” is the day, and “yyyy” is the year. Zero

through 19. If that individual is a nonresident alien

Item 1. Amends prior report.—Check Item 1 if this

(0) should precede any single-digit number. For

who does not have an SSN, enter “NONE” in the

Form 103 amends a previously filed report. Staple a

example, if the individual’s birth date is June 1, 1948,

space.

copy of the original report behind the amended one.

enter “06 01 1948” in Item 12.

Complete Part III in its entirety, but complete only

those other entries that are being amended.

Item 26. Date of birth.—Enter the individual’s date

Item 13. Method used to verify identity.—If an

of birth. For proper format, see the instructions under

individual conducts the transaction(s) on his/her own

Item 12 above.

Part I. Person(s) Involved in Transaction(s)

behalf, his/her name and address must be verified by

examination of an official credential/document or

Note: Section A must be completed in all cases. If an

Item 27. Method used to verify identity.—Any

internal record containing identification information

individual conducts a transaction on his/her own

individual listed in Items 17 through 19 must present

on a known customer (see Identification

an official document to verify his/her name and

behalf, complete only section A; leave Section B

Requirements above). Check box a if you examined

address. See the instructions under Item 13 above

BLANK. If a transaction is conducted by an individual

an official identification credential/document. Check

for more information. After completing Item 27, you

on behalf of another person(s), complete Section A

box b if you examined an acceptable internal casino

for each person on whose behalf the transaction is

must also complete Item 28.

record (i.e., credit, deposit, or check cashing account

conducted; complete Section B for the individual

record, or a CTRC worksheet) containing previously

Item 28. Describe identification credential.—

conducting the transaction.

verified identification information on a “known

Describe the identification credential used to verify

customer.” Check box c if the transaction is conducted

the individual’s name and address. See the instructions

Section A. Person(s) on Whose Behalf

on behalf of an organization. If box a or b is checked,

under Item 14 above for more information.

Transaction(s) Is Conducted (Customer)

you must complete Item 14. If box c is checked, do

not complete Item 14.

Item 2. Multiple persons.—Check Item 2 if this

Part II. Amount and Type of Transaction(s)

Part II identifies the type of transaction(s) reported and

transaction is being conducted on behalf of more than

Item 14. Describe identification credential.— If a

the amount(s) involved. You must complete all items

one person. For example, if John and Jane Doe cash

driver’s license, passport, or alien registration card was

that apply.

a check made out to them jointly at the casino, more

used to verify the individual’s identity, check as

than one individual has conducted the transaction.

appropriate box a, b, or c. If you check box d, you

Enter information in Section A for one of the

Item 29. Multiple transactions.—Check this box if

must specifically identify the type of document used

multiple currency transactions, none of which

individuals; provide information for the other

(e.g., enter “military ID” for a military or military/

individually exceeds $10,000, comprise this report.

individual on page 2, Section A. Attach additional

dependent identification card). A statement such as

sheets as necessary.

“known customer” in box d is not sufficient for

Items 30 and 31. Cash in and cash out.— Enter in

completion of Form 103. Enter in Item 14e the two-

Items 3, 4, and 5. Individual/Organization name.—

the appropriate spaces provided in Items 30 and/or

letter state postal code, two-letter country code, or

If the person on whose behalf the transaction(s) is

31, the specific currency amount for each “type of

the name of the issuer for that document, and enter

transaction” for a reportable Cash In or Cash Out. If

conducted is an individual,put his/her last name in

in Item 14f the number shown on that official

the casino engages in a Cash In or a Cash Out

Item 3, first name in Item 4 and middle initial in Item

document.

transaction that is not listed in Items 30a through 30g

5. If there is no middle initial, leave Item 5 BLANK. If

Fincen Form 103 - Multiple Persons Or Multiple Agents - 2003 Page 2

Related Articles

Related forms

Related Categories