Section B. Individual(s) Conducting Transaction(s)
(if other than above). Financial institutions should enter as much information as is available. However, there may be instances in which Items 15-25 may be left BLANK or incomplete. If Items 15-25 are left BLANK or incomplete, check one or more of the boxes provided to indicate the reasons.
Example: If there are multiple transactions that, if only when aggregated, the financial institution has knowledge the transactions exceed the reporting threshold, and therefore, did not identify the transactor(s), check box d for Multiple Transactions.
Items 15, 16, and 17. Individual’s Name. Complete these items if an individual conducts a transaction(s) on behalf of another person. For example, if John Doe, an employee of XY Grocery Store, makes a deposit to the store’s account, XY Grocery Store should be identified in Section A and John Doe should be identified in section B.
Items 18, 20, 21, 22, and 23.Address. Enter the permanent street address including ZIP Code of the individual. (See the instructions for Items 7 and 9 through 12.) Enter country code if not U.S. (Reference item 12).
Item 19. SSN/ITIN. If the individual has a Social Security Number, or Individual Taxpayer Indentifcation Number, enter it in Item 19. If the individual does not have an SSN/ ITIN, enter NONE.
Item 24. Date of Birth. Enter the individual’s date of birth. (See the instructions for Item 8.)
Item 25. If an Individual, Describe Method Used To Verify Identity. Enter the method used to identify the individual’s identity. (See General Instructions and the instructions for Item 14.)
PART II - Amount and Type of Transaction(s) Complete Part II to identify the type of transaction(s) and the amount(s) involved.
Items 26 and 27. Total Cash In/Total Cash Out. In the spaces provided, enter the total amount of currency received (Total Cash In) or total currency disbursed (Total Cash Out) by the financial institution. If foreign currency is exchanged, use the U.S. dollar equivalent on the day of the transaction (See “Foreign exchange rates”), and complete item 26a or 27a, whichever is appropriate.
If less than a full dollar amount is involved, increase that figure to the next highest dollar. For example, if the currency totals $20,000.05, show the total as $20,001.00.
Items 26a and 27a. Foreign cash in/Foreign cash out. If foreign currency is exchanged, enter the amount of foreign currency (Do not convert to U.S. dollars) in items 26a and 27a. Report country of origin in item 29.
Item 28. Date of Transaction. Insert eight numerals for each date. (See instructions for Item 8.)
Item 29. Foreign Country. If items 26a and/or 27a are completed indicating that foreign currency is involved, check Item 29 and identify the country. If multiple foreign currencies are involved, check box 36 and identify the additional country(s) and/or currency(s) involved.
Determining Whether Transactions Meet the Reporting Threshold.
Only cash transactions that, if alone or when aggregated, exceed $10,000 should be reported on the CTR. Transactions shall not be offset against one another.
If there are both Cash In and Cash Out transactions that are reportable, the amounts should be considered separately and not aggregated. However, they may be reported on a single CTR.
If there is a currency exchange, it should be aggregated separately with each of the Cash In and Cash Out totals.
Example 1: A person deposits $11,000 in currency to his savings account and withdraws $3,000 in currency from his checking account. The CTR should be completed as follows:
Cash In $11,000 and no entry for Cash Out. This is because the $3,000 transaction does not meet the reporting threshold.
Example 2: A person deposits $11,000 in currency to his savings account and withdraws $12,000 in currency from his checking account. The CTR should be completed as follows:
Cash In $11,000, Cash Out $12,000. This is because there are two reportable transactions. However, one CTR may be filed to reflect both.
Example 3: A person deposits $6,000 in currency to his savings account and withdraws $4,000 in currency from his checking account. Further, he presents $5,000 in currency to be exchanged for the equivalent in Euro’s. The CTR should be completed as follows:
Cash In $11,000 and no entry for Cash Out. This is because in determining whether the transactions are reportable, the currency exchange is aggregated with each of the Cash In and Cash Out amounts. The result is a reportable $11,000 Cash In transaction. The total Cash Out amount is $9,000, which does not meet the reporting threshold. Therefore, it is not entered on the CTR.
Example 4: A person deposits $6,000 in currency to his savings account and withdraws $7,000 in currency from his checking account. Further, he presents $5,000 in currency to be exchanged for the equivalent in Euro’s. The CTR should be completed as follows:
Cash In $11,000, Cash Out $12,000. This is because in determining whether the transactions are reportable, the currency exchange is aggregated with each of the Cash In and Cash Out amounts. In this example, each of the Cash In and Cash Out totals exceed $10,000 and must be reflected on the CTR.
Items 30-33. Check the appropriate item(s) to identify the following type of transaction(s):
30.Wire Transfer(s)
31.Negotiable Instrument(s) Purchased
32.Negotiable Instrument(s) Cashed
33.Currency Exchange(s)
Item 34. Deposits/Withdrawals. Check this item to identify deposits to or withdrawals from accounts, e.g. demand deposit accounts, savings accounts, time deposits, mutual fund accounts, or any other account held at the financial institution. Enter the account number(s) in Item 35.
Item 35. Account Numbers Affected (if any). Enter the account numbers of any accounts affected by the transactions that are maintained at the financial institution conducting the transaction(s).
Example 1: If a person cashes a check drawn on an account held at the financial institution, the CTR should be completed as follows:
Indicate negotiable instrument(s) cashed and provide the account number of the check.
If the transaction does not affect an account, make no entry.
Example 2: A person cashes a check drawn on another financial institution. In this instance, negotiable instrument(s) cashed would be indicated, but no account at the financial institution has been affected. Therefore, Item 35 should be left BLANK.
Item 36. Other (specify). If a transaction is not identified in Items 30-34, check Item 36 and provide an additional description. For example, a person presents a check to
purchase “foreign currency.” If multiple (more than one) foreign currencies are involved in the transaction, enter the amount of the largest foreign currency transaction in item 26a or 27a and that currency’s country-code of origin in item 29. Then check box 36 and enter the additional foreign currencies amount(s) and country-code(s) of origin in the space provided.
PART III - Financial Institution Where Transaction(s) Take Place
Item 37. Name of Financial Institution and Identity of Regulator or BSA Examiner. Enter the financial institution’s full legal name and identify the regulator or BSA examiner, using the following codes:
Regulator |
or |
BSA |
Examiner |
CODE |
|
|
|
|
Comptroller of the Currency (OCC) |
......................... |
1 |
Federal Deposit Insurance Corporation (FDIC) |
2 |
Federal Reserve System (FRS) |
3 |
Office of Thrift Supervision (OTS) |
4 |
National Credit Union Administration (NCUA) |
5 |
Securities and Exchange Commission (SEC) |
6 |
Internal Revenue Service (IRS) |
7 |
U.S. Postal Service (USPS) |
.................................... |
8 |
Commodity Futures Trading Commission (CFTC) |
9 |
State Regulator |
|
|
10 |
Items 38, 40, 41, and 42. Address. Enter the street address, city, state, and ZIP Code of the financial institution where the transaction occurred. If there are multiple transactions, provide information of the office or branch where any one of the transactions has occurred.
Item 39. EIN or SSN. Enter the financial institution’s EIN. If the financial institution does not have an EIN, enter the SSN of the financial institution’s principal owner.
Item 43. Routing (MICR) Number. If a depository institution, enter the routing (Magnetic Ink Character Recognition (MICR)) number.
SIGNATURE
Items 44 and 45. Title and signature of Approving
Official. The official who reviews and approves the CTR must indicate his/her title and sign the CTR.
Item 46. Date of Signature. The approving official must enter the date the CTR is signed. (See the instructions for Item 8.)
Item 47. Preparer’s Name. Type or print the full name of the individual preparing the CTR. The preparer and the approving official may not necessarily be the same individual.
Items 48 and 49. Contact Person/Telephone Number.
Type or print the name and telephone number of an individual to contact concerning questions about the CTR.
Paperwork Reduction Act Notice. The requested information is useful in criminal, tax, and regulatory investigations and proceedings. Financial institutions are required to provide the information under 31 U.S.C. 5313 and 31 CFR Chapter X, commonly referred to as the Bank Secrecy Act (BSA). The BSA is administered by the U.S. Department of the Treasury’s Financial Crimes Enforcement Network (FinCEN). You are not required to provide the requested information unless a form displays a valid OMB control number. The time needed to complete this form will vary depending on individual circumstances. The estimated average time is 19 minutes. If you have comments concerning the accuracy of this time estimate or suggestions for making this form simpler, you may write to the
Financial Crimes Enforcement Network, P. O. Box 39,
Vienna, VA22183. Do not send this form to this office. Instead, see When and Where to File in the instructions.