Fill out any useful information regarding the transactions or incident when checking “Other”. Structuring Money Laundering Alters transaction to avoid BSA recordkeeping requirement Exchanges small bills for large bills or vice versa Alters transaction to avoid CTR requirement Funnel account Customer cancels transaction to avoid BSA reporting and recordkeeping requirements Suspicion concerning the physical condition of funds Multiple transactions below BSA recordkeeping threshold Suspicion concerning the source of funds Multiple transactions below CTR threshold Suspicious designation of beneficiaries, assignees or joint owners Suspicious inquiry by customer regarding Suspicious EFT/ Wire transfers BSA reporting or recordkeeping requirements Suspicious exchange of currencies Other: Suspicious receipt of government payments or benefits Terrorist Financing Suspicious use of multiple accounts Known or suspected terrorist / terrorist Suspicious use of noncash monetary organization instruments Other: Suspicious use of third-party transactors (straw-man ) Fraud Trade Based Money Laundering / Black ACH Market Peso Exchange Business loan Transaction out of pattern for customer (s) Check Other: Consumer Loan Other Suspicious Activities Credit / Debit Card Account takeover Mass-marketing Bribery or gratuity Pyramid scheme Counterfeit instruments Wire Identification / Documentation Elder financial exploitation Embezzlement, theft or disappearance of Changes spelling or arrangement of name funds Forgeries Multiple individuals with same or similar identities Human smuggling Provided questionable or false documentation Human trafficking Refused or avoided request for Identity theft documentation Single individual with multiple Little or no concern for product performance penalties. fees, or tax consequences identities Misuse of / cooling off / right of Other: “free look” rescission
Fill out any useful information regarding the transactions or incident when checking “Other”. Structuring Alters transaction to avoid BSA recordkeeping requirement Alters transaction to avoid CTR requirement Customer cancels transaction to avoid BSA reporting and recordkeeping requirements Multiple transactions below BSA recordkeeping threshold Multiple transactions below CTR threshold Suspicious inquiry by customer regarding BSA reporting or recordkeeping requirements Other: Terrorist Financing Known or suspected terrorist / terrorist organization Other: Fraud ACH Business loan Check Consumer Loan Credit / Debit Card Mass-marketing Pyramid scheme Wire Identification / Documentation Changes spelling or arrangement of name Multiple individuals with same or similar identities Provided questionable or false documentation Refused or avoided request for documentation Single individual with multiple identities Other: Money Laundering Exchanges small bills for large bills or vice versa Funnel account Suspicion concerning the physical condition of funds Suspicion concerning the source of funds Suspicious designation of beneficiaries, assignees or joint owners Suspicious EFT/ Wire transfers Suspicious exchange of currencies Suspicious receipt of government payments or benefits Suspicious use of multiple accounts Suspicious use of noncash monetary instruments Suspicious use of third-party transactors (straw-man ) Trade Based Money Laundering / Black Market Peso Exchange Transaction out of pattern for customer (s) Other: Other Suspicious Activities Account takeover Bribery or gratuity Counterfeit instruments Elder financial exploitation Embezzlement, theft or disappearance of funds Forgeries Human smuggling Human trafficking Identity theft Little or no concern for product performance penalties. fees, or tax consequences Misuse of “free look” / cooling off / right of rescission
Generic_BSA_Referral_Form.docx