Suspicious Transactions / Suspicious Activity Report
ADVERTISEMENT
1
2Place name of Institution here
SUSPICIOUS TRANSACTIONS / SUSPICIOUS ACTIVITY REPORT
Made in accordance with the Provisions of Section 55(3)
Ref. No…………
of the Proceeds of Crime Act, Ch. 11:27
(as amended)
ALWAYS COMPLETE ENTIRE REPORT
Instructions:
Reports on suspicious Financial Transactions shall be made to the Financial Intelligence Unit within fourteen (14) days of the date the
transaction was deemed to be suspicious by the institution.[8.55(3)]
Notice to staff
It is an offence to fail to report a suspicious transaction for which the penalty is (a) on summary conviction, five hundred thousand dollars and
imprisonment for a term of two years (b) on conviction on indictment, a fine of three million dollars and imprisonment for a term of seven years.
[S.57(l)]
1.
Check appropriate box:
a.
( ) Initial Report
b.
( ) Corrected Report
c.
( ) Supplemental Report
_____________________________________________________________________________________
PART I
R
F
I
R
B
EPORTING
INANCIAL
NSTITUTION OR
ELEVANT
USINESS
ACTIVITY INFORMATION
2.
Name of Financial Institution or Person or Company engaged in a relevant business activity ……………………………………………………………...
3.
Address of Financial Institution or Person or Company engaged in a relevant business activity ………………………………….…………………………
4.
Address of Branch Office(s) where activity occurred.....................................................................................………………………….……………………
5.
Asset Size of Financial Institution or Person or Company engaged in a relevant business activity: $……………………………………………………..
6.
If Institution or relevant business activity closed, date closed ................. /................ /………..
DD .......
MM..........YY
7.
Account Number(s) affected (if any)
..................... .. ……………………………………………………………………………………………………………………………...……………….
...........................................................................................................................................................................…………………………………………….
………………………………………………………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………………………………………………
……………..………………………………………………………………………………………………………………………………………………….
8.
Have any of the Institution's or relevant business accounts related to this matter been closed?
(a)
( )Yes
if yes identify
……………………………………. / ……………………………………
……………………………………. / ……………………………………
……………………………………. / ……………………………………
(b)
( ) No
_____________________________________________________________________________________________________________________________
PART II
S
I
USPECT
NFORMATION
9.
Last Name or Name of Entity: …………………………………… 10. First Name:……………………………… 11. Middle Initial:……………….
………………………………………..
…………………………………
………………..
12.
Address:
………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………………
13.
Date of Birth ………/…………/…….......
14.
Home No.: .……… ..................... ……………………………
DD
MM
YY
14 a. Cell No. ………………………………………………………
(a)
Co.Reg.No.................................................................
15.
Work No………………………………………………………
(b)
VAT Reg. No. …………………………………….
(c)
B.I.R. No. ………………………………………….
16.
Occupation:
…………………………………………………………………………..
17.
Forms of Identification for Suspect:
(a) ( ) Driver’s License
(b) ( ) Passport
(c) ( ) Trinidad & Tobago I.D. Card
(d) ( ) Other
………Number……………………………………..
………Issuing Authority……………………………………………………………………...
………Number……………………………………..
………Issuing Authority……………………………………………………………………...
………Number……………………………………..
………Issuing Authority……………………………………………………………………...
………Number……………………………………..
………Issuing Authority……………………………………………………………………...
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal