SCHEDULE 1(Subsection 9(1) and sections 11 and 12.1)Suspicious Transaction or Attempted Transaction Report
PART A
Information on Place of Business Where Transaction or Attempted Transaction Occurred
1*
Type of reporting person or entity, as described in paragraphs 5(a) to (h) and (k) to (m) of the Act, and, if reporting person or entity is referred to in paragraph (5)(i) or (j) of the Act, type of business, profession or activity of reporting person or entity, as described in sections 3 to 8 of these Regulations
2*
Identification number of place of business where transaction or attempted transaction occurred (e.g., institution’s identification number, licence number or registration number), if applicable
3*
Full name of reporting person or entity
4*
Full address of place of business where transaction or attempted transaction occurred
5*
Name and telephone number of contact person
PART B
Information on Transaction or Attempted Transaction
1*
Date of transaction or attempted transaction or night deposit indicator
2
Time of transaction or attempted transaction
3
Posting date (if different from above)
4*
Purpose and details of the transaction or attempted transaction, including type of funds, amount of transaction or attempted transaction, currency of transaction or attempted transaction, and, if applicable, name and number of each other institution and name and account number of each other person or entity
5*
Disposition of funds, amount of disposition, currency of disposition, and, if applicable, name and number of each other institution and name, account number and policy number of each other person or entity
6*
Method by which the transaction was conducted or attempted (in branch or office, ABM, armoured car, mail deposit, courier, telephone or other)
7
Identification number of person who first detected a fact respecting a suspicious transaction or attempted transaction
8*
Whether the transaction has been completed or not
9*
If transaction not completed, the reason why it was not completed
PART C
Account Information (if applicable)
1*
Account number
2*
Branch number or transit number
3*
Type of account (personal, business, trust or other)
4*
Full name of each account holder
5*
Type of currency of the account
6
Date account opened
7
Date account closed, if applicable
8*
Status of account (active, inactive or dormant)
PART D
Information on Person Conducting or Attempting To Conduct Transaction
1
Person’s full name
2*
Client number provided by reporting person or entity, if applicable
3
Person’s full address
4
Person’s country of residence
5
Person’s personal telephone number
6
Person’s citizenship
7
Person’s type of identifier (e.g., driver’s licence, birth certificate, provincial health insurance card — if such use of the card is not prohibited by the applicable provincial law —, passport, Record of Landing or permanent resident card) and identifier number
8
Place of issue of person’s identifier (province or state, country)
9
Person’s date of birth
10
Person’s occupation
11
Person’s business telephone number
12
Person’s employer
13
Employer’s full business address
14
Employer’s business telephone number
PART E
Information on Entity on Whose Behalf Transaction Is Conducted or Attempted (if applicable)
1
Entity’s full name
2
Full name of each person — up to three — who is authorized to bind the entity or act with respect to the account
3
Entity’s type of business
4
Entity’s full address
5
Entity’s telephone number
6
Entity’s incorporation number and place of issue, if applicable
PART F
Information on Person on Whose Behalf Transaction Is Conducted or Attempted (if applicable)
1
Person’s full name
2
Person’s full address
3
Person’s personal telephone number
4
Person’s business telephone number
5
Person’s citizenship
6
Person’s type of identifier (e.g., driver’s licence, birth certificate, provincial health insurance card — if such use of the card is not prohibited by the applicable provincial law —, passport, Record of Landing or permanent resident card) and identifier number
7
Place of issue of person’s identifier (province or state, country)
8
Person’s date of birth
9
Person’s country of residence
10
Person’s occupation
11
Person’s employer
12
Employer’s full business address
13
Employer’s business telephone number
14
Relationship of person conducting the transaction or attempted transaction to the person on whose behalf the transaction or attempted transaction is conducted
PART G
Description of Suspicious Activity
1*
Detailed description of the grounds to suspect that the transaction or attempted transaction is related to the commission of a money laundering offence or terrorist activity financing offence
