Fillable Fincen Form 103 - Currency Transaction Report By Casinos (Page 2 of 4) in pdf

FinCEN Form 103 (Rev. 8-08)

Page

Multiple Persons or Multiple Agents

(Complete applicable parts below if box 2 or box 17 on page 1 is checked.)

Part I

Person(s) Involved in Transaction(s)

Section A--Person(s) on Whose Behalf Transaction(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

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:

Examined identification credential/document

Known Customer - information on file

Organization

*15 Describe identification credential: a

Driver’s license/State ID b

Passport

Alien registration

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:

Examined identification credential/document

Known Customer - information on file

29 Describe identification credential: a

Driver’s license/State ID b

Passport

Alien registration

Other

Issued by:

Number:

General Instructions

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

increase in the amount of the currency bet would represent

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

a new bet of currency and a transaction in currency.) or,

business day of the casino by which it keeps its books

Form 103. Use this revision of Form 103 for filing on

Jackpots from slot machines or video lottery terminals.

•

and records for business, accounting, and tax purposes.

reportable transactions.

Multiple transactions must be treated as a single

Identification requirements. All individuals (except

transaction if the casino has knowledge that: (a) they

Suspicious Transactions. If a transaction is greater

employees conducting transactions on behalf of armored

are made by or on behalf of the same person, and (b)

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

car services) conducting a reportable transaction(s) for

they result in either Cash In or Cash Out by the casino

must file a Form 103 and must report suspicious

themselves or for another person must be identified by

totaling more than $10,000 during any one gaming day.

transactions and activities on FinCEN Form 102,

means of an official or otherwise reliable record.

Reportable transactions may occur at a casino cage,

Suspicious Activity Report by Casinos (SARC). Also,

Acceptable forms of identification include a driver’s

gaming table, and/or slot machine/video lottery terminal.

casinos are required to use the SARC form to report

license, military or military dependent identification card,

The casino should report both Cash In and Cash Out

suspicious activities involving or aggregating at least

passport, alien registration card, state issued identification

transactions by or on behalf of the same customer on a

$5,000 in funds. Do not use Form 103 to (a) report

card, cedular card (foreign), or a combination of other

single Form 103. Do not use Form 103 to report receipts

suspicious transactions involving $10,000 or less in

unexpired documents that contain an individual’s name

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

currency or (b) indicate that a transaction of more

and address and preferably a photograph and are

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

than $10,000 is suspicious.

normally acceptable by financial institutions as a means

8300, Report of Cash Payments Over $10,000 Received

In situations involving suspicious transactions

of identification when cashing checks for persons other

in a Trade or Business.

requiring immediate attention, such as when a

than established customers.

reportable transaction is ongoing, the casino or

For casino customers granted accounts for credit,

Exceptions. A casino does not have to report

deposit, or check cashing, or on whom a CTRC containing

card club shall immediately notify, by telephone,

transactions with:

verified identity has been filed, acceptable identification

appropriate law enforcement and regulatory

domestic banks; or

information obtained previously and maintained in the

•

authorities in addition to filing a timely

currency dealers or exchangers, or check cashers, as

casino’s internal records may be used as long as the

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suspicious activity report.

defined in 31 C.F.R. § 103.11(uu), and which are

following conditions are met. The customer’s identity is

conducted pursuant to a contractual or other agreement

reverified periodically, any out-of-date identifying

Who must file. Any organization duly licensed or

covering the financial services in 31 C.F.R.

information is updated in the internal records, and the

authorized to do business as a casino, gambling

§ § 1 0 3 . 2 2 ( b ) ( 2 ) ( i ) ( H ) , 1 0 3 . 2 2 ( b ) ( 2 ) ( i i ) ( G ) ,

date of each reverification is noted on the internal record.

casino, or card club in the United States and having

and103.22(b)(2)(ii)(H).

For example, if documents verifying an individual’s

gross annual gaming revenues in excess of $1 million

identity were examined and recorded on a signature

Also, a casino does not have to report the following

must file Form 103. This includes the principal

card when a deposit or credit account was opened, the

types of transactions:

headquarters and every domestic branch or place

casino may rely on that information as long as it is

Cash ins when it is the same physical currency

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of business of the casino or card club. The

reverified periodically.

previously wagered in a money play on the same table

requirement includes state-licensed casinos (both

game without leaving the table;

land-based and riverboat), tribal casinos, and state-

When and where to file: This form can be e-filed

Bills inserted into electronic gaming devices in multiple

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licensed and tribal card clubs. Since card clubs are

through the Bank Secrecy Act E-filing System.

transactions (unless a casino has knowledge pursuant to

subject to the same reporting rules as casinos, the

Go to to register.

31 C.F.R. 103.22(c)(3));

term “casino” as used in these instructions refers to

This form is also available for download on the Web at

Cash outs won in a money play when it is the same

both a casino and a card club.

•

, or may be ordered by calling the IRS

physical currency wagered, (Note: However, when a

Forms Distribution Center at (800) 829-3676.

customer increases a subsequent cash bet (i.e., money

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

play), at the same table game without departing, the

transaction involving either currency received (Cash

Fincen Form 103 - Currency Transaction Report By Casinos Page 2

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