SUSPICIOUS TRANSACTIONS / SUSPICIOUS …

1 SUSPICIOUS TRANSACTIONS / SUSPICIOUS activity REPORTFor official use onlyYour reference in accordance with the Provisions of Section 55(3) of the Proceeds of Crime Act, Ch. 11:27 (as amended)ALWAYS COMPLETE ENTIRE REPORTI nstructions: Reports on SUSPICIOUS Financial Transaction/ activity shall be made to the Financial Intelligence Unit as soon as possible, but in any event, within fourteen (14) days of the date on which the financial institution or listed business knew or had reasonable grounds to suspect that the funds used for a transaction were the proceeds of a specified offence.[ (3B)]Notice to staff It is an offence to fail to report a SUSPICIOUS transaction or activity 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.

2 [ (l)] 1. Check appropriate box: a. Initial report b. Corrected report c. Supplemental ReportPART IREPORTING FINANCIAL INSTITUTION OR RELEVANT BUSINESSACTIVITY INFORMATIONPART IISUSPECT 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 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.

3 /.. /.. 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 9. Last Name or Name of Entity: .. 10. First Name:.. 11. Middle Initial:.. 12. Address: .. 13. Date of Birth ../../.. 14. Home DD MM YY 14 a. Cell No.. (a) Co. Reg. 15. Work No .. (b) VAT Reg. No.. (c) No.. 16. Occupation.

4 17. Forms of Identification for Suspect: (a) ( ) Driver s License (b) ( ) Passport (c) ( ) Trinidad & Tobago Card (d) ( ) Other ..Issuing ..Issuing ..Issuing ..Issuing TRANSACTIONS / SUSPICIOUS activity report (NARRATIVE report ) CONTINUED ON SEPARATE SHEETS ( ) YES ( ) NO DOCUMENTS ATTACHED ( ) YES ( ) NO PART IIISUSPICIOUS TRANSACTIONS OR activity INFORMATIONPART IV(Deleted by Act No. 10 of 2009).PART VPREPARER INFORMATIONPART VICONTACT FOR ASSISTANCE(IF DIFFERENT THAN PREPARER INFORMATION IN PART IV)PART VIISUSPICIOUS activity INFORMATION/EXPLANATION/DESCRIPTION 18. Relationship to Financial Institution: ( ) (a) Accountant ( ) (e) Borrower ( ) (i) Employee ( ) (b) Agent ( ) (f ) Broker ( ) (j) Officer ( ) (c) Appraiser ( ) (g) Customer ( ) (k) Shareholder ( ) (d) Attorney ( ) (h) Director ( ) (l) Other 19.

5 Date of SUSPICIOUS TRANSACTIONS or activity : ../ ../ .. 20. Dollar amount involved in known or SUSPICIOUS TRANSACTIONS or activity DD MM YY $ .. 21. Last Name: .. 22. First Name: .. 23. Middle Initial: .. 24. Title: .. 25. Phone Number: .. 26. Date Prepared: ../../.. DD MM YY 27. Last Name: .. 28. First Name: .. 29. Middle Initial:.. 30. Title: .. 31. Phone Number: 32. Institution: .. Explanation/Description of known or suspected violation of law or SUSPICIOUS activity .

6 This section of the report is critical. The care with which it is written may make the difference in whether or not the described conduct and its possible criminal nature are clearly understood. Provide below a chronological and complete account of the possible violation of law, including what is unusual, irregular or SUSPICIOUS about the transaction, using the following checklist as you prepare your account. If necessary, continue the narrative on a duplicate of this page. a) Describe supporting documentation and retain for 6 years. b) Explain who benefitted financially or otherwise, from the transaction, how much, and how. c) Retain any confession, admission, or explanation of the transaction provided by the suspect and indicate to whom and when it was given.

7 D) Retain any confession, admission, or explanation of the transaction provided by any other person and indicate to whom and when it was given. e) Retain any evidence of cover-up or evidence of an attempt to deceive institution. f ) Indicate where the possible violation took place ( , main office, branch, other). g) Indicate whether the possible violation is an Isolated Incident or relates to other TRANSACTIONS . h) Indicate whether there is any related litigation; if so, specify. i) Recommend any further investigation that might assist law enforcement authorities. j) Indicate whether any information has been excluded from this report ; if so, why? k) Indicate whether currency and/or monetary Instruments were involved.

8 If so, provide the amount and/or description. l) Indicate any account number that may be involved or affected.(Narrative report )