Fincen Form 107 – Fill Out and Use This PDF

Part IV

(continued)

2

25

Enter the number of branches of the registrant.

Reminder: do not separately register each branch.

_

_

_

_

_

See instructions for an explanation of the term “branch”.

_ _

_ _

_ _

_ _

_ _

26

Money services business activities of the registrant. Check as many as apply. See instructions for an explanation of the terms ” issuer”,

“seller”, “redeemer”, “check casher”,

and “money transmitter”.

a

Issuer of traveler’s checks

d

Issuer of money orders

g

Currency dealer or exchanger

b

Seller of traveler’s checks

e

Seller of money orders

h

Check casher

c

Redeemer of traveler’s checks

f

Redeemer of money orders

i

Money transmitter

27

Is any part of the registrant’s money services business an informal value transfer system?

a

Yes

b

No

See the explanation of “money transmitter” in the instructions.

28

Is any part of the registrant’s money services business conducted as a mobile operation?

a

Yes

b

No

29

Enter the number of agents authorized to conduct each money services business activity. Do not include branches, or persons who are

solely employees. See instructions for an explanation of the term “agent”.

a

Traveler’s check sales

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

e

Currency exchange

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

or dealer

b

Traveler’s check redemption

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

f

Check cashing

_ _ _

__ _

__ _

__ _

__ _

c

Money order sales

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

g

Money transmission

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

d

Money order redemption

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

Part V

Primary Transaction Account for MSB Activities

30 If the registrant has more than one transaction account for money services business activities check here.

See instructions for an explanation of the term “transaction account”.

The registrant’s primary transaction account is the one that has the greatest annual dollar amount of money services business activity.

In items 31 through 36 enter information about the registrant’s primary transaction account for money services business activities.

31

Name of financial institution where the primary transaction account is held

32

Address

33 City

34

State

35 ZIP Code

36

Primary transaction account number

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

Part VI

Location of Supporting Documentation

If the supporting documentation is kept at the U.S. location reported in Part II

check here

and continue to Part VII.

37

Address

38

City

39 State

40 ZIP Code

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

_ _ _

Part VII

Authorized Signature

41

Signature

42 Print name

43

Title

44 Date of signature

______ / _____ / _______

MM DD YYYY

FinCEN Form 107a

Registration of Money Services Business Instructions

1

General Information

value, the provision of stored value services does

9. A “redeemer” is a business that accepts

not relieve it of the responsibility to register , if

instruments in exchange for currency or other

Who Must Register

required, as a provider of those other services.

instruments for which it is not the issuer. You are

not a redeemer if you take the instruments in

Generally each money services business must

For the regulatory definition of “money services

exchange for goods or general services, provided

business” see 31 CFR 1010.100(t) and (ff).

that the amount of cash returned is not more than

register with the Department of the Treasury. This

form must be used by a money services business

$1,000 for any one customer on any day.

The following terms are used in the form and

(also referred to as an MSB) to register. However,

10. A “seller” is a business that issuers authorize,

not all MSBs are required to register. For example,

instructions to describe a money services business:

through written agreement or otherwise, to sell

if you are an MSB solely because you are an agent

1. An “agent” is a separate business entity from the

their instruments or their send and receive transfer

of another MSB, you are not required to register.

issuer that the issuer authorizes, through written

services.

The discussion below will help you determine

whether or not you are an MSB that is required to

agreement or otherwise, to sell its instruments or,

11. A “transaction account” is a deposit or account

in the case of funds transmission, to sell its send

register. For more information visitwww.msb.gov.

and receive transfer services. A person who is

on which the depositor or account holder is

The term money services business includes:

solely an employee of the MSB is not an agent of

permitted to make withdrawals by negotiable or

1. Currency dealers or exchangers who exchange

that MSB.

transferable instrument, payment orders of

withdrawal, telephone transfers, or other similar items

more than $1,000 for any one customer on any

2. A “branch” is an owned location of either an

for the purpose of making payments or transfers to

day.

issuer or agent at which financial services are sold.

third persons or others. Such terms include demand

2. Check cashers who cash checks totaling more

An MSB should not separately register each of its

deposits, negotiable order of withdrawal accounts,

branches. A mobile operation owned by an MSB is

savings deposit subject to automatic transfers, and

than $1,000 for any one customer on any day.

a branch of that MSB. The MSB’s headquarters is

share draft accounts. See 12 USC 461(b)(1)(c).

3. Issuers of traveler’s checks, money orders or

not a branch. If the MSB has only one location,

When to Register

stored value who issue more than $1,000 in

that location is not a branch.

traveler’s checks, money orders or stored value

3. A “check casher” is a person engaged in the

Initial registration: File the form within 180 days

for any one customer on any day.

business of providing cash to persons in return for

after the date the business is established.

4. Sellers of traveler’s checks, money orders or

a check.

Renewal: Each MSB must renew its registration

stored value who sell more than $1,000 in traveler’s

4. A “currency dealer or exchanger” is a person

every two years, on or before December 31.

See

checks, money orders or stored value for any one

who engages in the physical exchange of currency

31 CFR 1022.380(b)(2). For example, if an MSB

customer on any day.

for retail customers.

registered on October 15, 2003, it must file a

5. Redeemers of traveler’s checks, money orders

renewal by December 31, 2004, and then every

5. “Informal value transfer system”. See explanation

24 months thereafter (on or before December 31,

or stored value who redeem more than $1,000 in

of the term money transmitter.

2006, then December 31, 2008, etc.). Renewals

traveler’s checks, money orders or stored value

for any one customer on any day.

6. An “issuer” is the business that is ultimately

must be submitted on a new Form 107. Photo

copies of previously submitted forms or

6. Money transmitters.

responsible for payment of money orders or

facsimiles will not be accepted for renewal

travelers checks as the drawer of such instruments,

purposes

7. U.S. Postal Service.

or a money transmitter that has the obligation to

Correction: Use the form to correct a prior report.

guarantee payment of a money transfer.

The following are not required to register:

Complete Part I in its entirety and only those other

7. A “money transmitter” is a person that engages

entries that are being added or changed. Staple a

1. A business that is an MSB solely because it serves

as an agent of another MSB. For example, a

as a business in the transfer of funds through a

copy of the prior report (or the acknowledgment

financial institution.

from ECC-D if received) to the corrected report.

supermarket corporation that sells money orders

for an issuer of money orders is not required to

Generally, acceptance and transmission of funds as

Re-registration: Refile a new registration form

an integral part of the execution and settlement of

register. This is true even if the supermarket

corporation serves as an agent for two or more

a transaction other than the funds transmission itself

when one of the following events occurs:

(for example, in connection with the bona fide

1. a change in ownership requiring re-registration

MSBs. However, an MSB that serves as an agent of

another MSB and engages in MSB activities on its

sale of securities) will not cause a person to be a

under state registration law;

own behalf must register . For example, a

money transmitter.

2. more than 10 percent of voting power or equity

supermarket corporation must register if, in addition

An “informal value transfer system” is a kind of

interest is transferred (except certain publicly-

money transmitter . An informal value transfer

traded companies) or;

to acting as an agent of the money order issuer, it

provides check cashing or currency exchange

system includes any person who engages as a

3. the number of agents increases by more than 50

business in an informal money transfer system or

percent.

services on its own behalf in an amount greater

than $1,000 for any one person on any day.

any network of people who engage as a business in

Where to Register

facilitating the transfer of money domestically or

2. The United States Postal Service, any agency of

internationally outside of the conventional financial

Send your completed form to:

the United States, of any state, or of any political

institutions system.

subdivision of any state.

8. A “person” is an individual, a corporation, a

Enterprise Computing Center - Detroit

partnership, a trust or estate, a joint stock company,

Attn: Money Services Business Registration

3. At this time, persons are not required to register

an association, a syndicate, joint venture, or other

P.O. Box 33116

to the extent that they issue, sell or redeem stored

unincorporated organization or group, an Indian

Detroit, MI 48232-0116

value. If, however , a money services business

Tribe (as that term is defined in the Indian Gaming

Regulatory Act), and all entities cognizable as legal

provides money services in addition to stored

personalities.

FinCEN Form 107

Registration of Money Services Business Instructions

3

one) as appropriate, and do not check any

Items 32 to 35-- Enter the permanent address

criminal penalties, which may include

individual state or territory boxes. If box a, b, or c

for the financial institution.

imprisonment for up to five (5) yearsand criminal

does not apply, check as many state or territory

Item 36--Primary transaction account number.

fines. See 18 USC 1960. Note: This registration

boxes as necessary . If a service is of fered on

does not satisfy any state or local licensing or

tribal lands, mark the box for the state, territory

Enter the primary transaction account number.

registration requirement s.

or district in which the tribal lands are located.

Part VI

Location of Supporting

Paperwork Reduction Act Notice.

Item 25--Enter the number of branches of the

Documentation

The purposes of this form are to provide an effec-

registrant. Enter the number of branches of the

tive and consistent means for money services busi-

money services business at which one or more

General: The registrant must retain for five (5)

nesses to register with the Financial Crimes En-

MSB activities are offered. If there are no branches,

years certain information at a location within the

forcement Network, and to assure maintenance of

enter zero. See the General Information for an

United States. That information includes:

reports or records where such reports or records

explanation of the term “branch”.

1. A copy of the registration form.

have a high degree of usefulness in criminal, tax,

or regulatory investigations or proceedings. This

2. Annual estimate of the volume of the registrant’s

Item 26--MSB activities of the registrant. Items

business in the coming year.

report is required by law , pursuant to authority

contained in Public Law 103-305; 31 USC 5330; 5

25a through 2 5i are MSB activities. Check t he

3. The following information regarding ownership

USC 301; 31 CFR Chapter X. The information

box of each MSB activity conducted b y t he

or control of the business: the name and address

collected may be provided to those officers and

registrant at its branches.

See the General

of any shareholder holding more than 5% of the

employees of any constituent unit of the Depart-

Information for an explanation of the terms “issuer”,

registrant’s stock, any general partner, any trustee,

ment of the Treasury who have a need for the

“seller”, “redeemer”, “check casher”, and “money

and/or any director or officer of the business.

records in the performance of their duties. The

transmitter”.

4. An agent list.

records may be referred to any other depart-

If the registrant has agents it must prepare and

ment or agency of the United States, to any State,

Item 27--Informal value transfer system. If any

maintain a list of its agents. That agent list must be

or Tribal Government. Public reporting and re-

part of theregistrant’s moneyservices business is an

updated annually and retained by the business at

cordkeeping burden for this information collec-

informal value transfer system, check yes. An

the location in the United States reported on this

tion is estimated to average 30 minutes per re-

informal value transfer system is a kind of money

registration form in Part II or Part VI.The agent list

sponse, and includes time to gather and maintain

should not

be filed with this registration form.

data for the required report, review the instruc-

transmitter. See the General Information

explanation of the term “money transmitter”.

The agent list must include:

tions, and complete the information collection.

a. Each agent’s name,

Send comments regarding this burden estimate,

Item 28 --Mobile o peration. If any part of the

b. Each agent’s address,

including suggestions for reducing the burden,

registrant’s money services business isconducted

c. Each agent’s telephone number,

to the Office of Management and Budget Paper-

as a mobile operation, check yes. A mobile

d. The type of service(s) provided by each agent on

work Reduction Project, Washington, DC 20503

operation is one based in a vehicle. For example,

behalf of theregistrant,

and to the Paperwork Reduction Act; Department

of the Treasury, Financial Crimes Enforcement

a check cashing service offered from a truck is a

e. A listing of the months in the immediately

Network, P.O. Box 39 , V ienna, VA 22183-0039.

mobile operation. For purposes of Item 25, each

preceding 12 months in which the gross transaction

The agency may not conduct or sponsor , and an

mobile operation should be counted as a separate

amount of each agent with respect to financial products/

branch.

services issued by theregistrant exceeds $100,000,

organization (or a person) is not required to re-

spond to, a collection of information unless it dis-

f. The name and add ress of any depository

plays a currently valid OMB control number .

Item 29--Number of agents. Enter the number of

institution at which each agent maintains a transaction

agents that the registrant has authorized to sell or

account for the money services business activities

Privary Act Notice.

Pursuant to the requirements of Public Law 93-

distribute its MSB services. Do not count branches

conducted by the agent on behalf of theregistrant,

579 (Privacy Act of 1974), notice is hereby given

or any person who is solely an employee of the

g. The year in which each agent first became an

that, in accordance with 5 U.S.C. 552a(e), the au-

MSB. A bank is not an agent for this purpose. See

agent of theregistrant, and

thority to collect information on

FinCEN Form 107

the General Information for an explanation of the

h. The number of branches or subagents of each

is Public Law 103-305; 31 USC 5330; 5 USC 301;

term “agent”.

agent.

31 CFR Chapter X. The Department of the Trea-

Part V Primary TransactionAccount for

Items 37 to 40--If the supporting documentation

sury may use and share the information with any

other department or agency of the United States,

MSB Activities

is retained

at a location other than the address

to any State, or Tribal Government, or part thereof,

listed in Part II, enter the location information in

upon the request of the head of such department

Item 30--Check the box if the registrant has more

items 37 through 40.

or agency, or authorized S tate or Tribal Govern-

than one primary transaction account for money

Part VII

Authorized Signature

ment official for use in a criminal, tax, or regula-

services business activities. Example: If the

tory investigation or proceeding, and to foreign

registrant is both an issuer of money orders and an

governments in accordance with an agreement, or

Items 41 to 44--The owner or controlling person

a treaty.

issuer of traveler’s checks and the registrant has

Disclosure of this information

is mandatory. Civil

separate clearing accounts for money orders and

listed in Part III must sign and date the form as

and criminal penalties, including in certain cir-

traveler’s checks, the box should be checked.

indicated in Part VII. If the owner or controlling

cumstances a fine of not more than $5,000 per

Item 31--Name of the financial institution where

person is a corporation, a duly authorized officer

day and imprisonment of not more than five years,

the primary transaction account is held. Enter

of the corporation must execute the form on behalf

the name of the bank or other

financial institution

of the corporation. Enter the date this document

are provided for failure to file the form, supply

information requested by the form, and for filing a

where the registrant has its primary transaction

was signed.

false or fraudulent form. Disclosure of the social

account. I f you indicated that the registrant has

Penalties for failure to comply: Any person who

security number or taxpayer identification number

more than one primary transaction account in Item

is mandatory. The authority to collect is 31 CFR

30, enter information about the account with the

fails to comply with the requirements to register,

Chapter X. The social security number/taxpayer

greatest money service activity transaction volume

keep records, and/or maintain agent lists

identification number will be used as a means to

as measured by value in dollars. See the General

pursuant to 31 CFR 10 22.380 may be liable for

identify the individual or entity who files the re-

Information for an explanation of the term

civil penalties of up to $5,000 for each violation.

port.

“transaction account”.

Failure to comply also may subject a person to