Fincen Form 109 – Fill Out and Use This PDF

FinCEN Form 109a Suspicious Activity Report by Money Services Business -- Instructions

1

Safe Harbor

i. The transaction involves funds derived

4. SSN -- Social Security Number

from illegal activity or is intended or conducted

5. Instruments -- includes Money order(s)

Federal law (31 U.S.C. 5318(g)(3)) provides

in order to hide or disguise funds or assets derived

and/or Traveler’s Check(s)

complete protection from civil liability for all

from illegal activity (including, without limitation,

6. Redeemer --A business that accepts

reports of suspicious transactions made to

the nature, source, location, ownership or control

appropriate authorities, including supporting

of such funds or assets) as part of a plan to violate

instruments in exchange for currency or other

documentation, regardless of whether such

or evade any Federal law or regulation or to avoid

instruments for which it is not the issuer is a

reports are filed pursuant to this report’s

any transaction reporting requirement under

redeemer. The MSB definition in 31 CFR

instructions or are filed on a voluntary basis.

Federal law or regulation;

1010.100(ff)(4) extends to “redeemers” of

Specifically, the law provides that a financial

money orders and traveler’s checks only insofar

institution, and its directors, officers, employees

ii. The transaction is designed, whether

as the

and agents, that make a disclosure of any possible

through structuring or other means, to evade any

instruments involved are redeemed for monetary

violation of law or regulation, including in

regulations promulgated under the Bank Secrecy

value — that is, for currency or monetary or other

connection with the preparation of suspicious

Act; or

negotiable or other instruments. The taking of the

activity reports, “shall not be liable to any person

instruments in exchange for goods or general ser-

under any law or regulation of the United States,

iii. The transaction has no business or

vices is not redemption under BSA regulations.

any constitution, law, or regulation of any State or

apparent lawful purpose and the money services

C. General Instructions

political subdivision of any State, or under any

business knows of no reasonable explanation for

contract or other legally enforceable agreement

the transaction after examining the available facts,

(including any arbitration agreement), for such

including the background and possible purpose

1. This form should be e-filed through the

disclosure or for any failure to provide notice of

of the transaction.

Bank Secrecy Act E-filing System. Go to

such disclosure to the person who is the subject

iv. The transaction involves the use of the

http://bsaefiling.fincen.treas.gov/index.jsp

of such disclosure or any other person identified

to register. This form is also available for down-

in the disclosure”.

money services business to facilitate criminal

load on the Financial Crimes Enforcement

activity.

Network’s Web site at www.fincen.gov, or may

Notification Prohibited

b. To the extent that the identification of

be ordered by calling the IRS Forms Distribution

Center at (800) 829-3676.

transactions required to be reported is derived

Federal law (31 U.S.C. 5318(g)(2)) provides that

from a review of clearance records or other similar

2. If not filed electronically or through magnetic

a financial institution, and its directors, officers,

records of money orders or traveler’s checks that

media, send each completed suspicious activity

employees, and agents, who report suspicious

have been sold or processed, an issuer of money

report to:

transactions to the government voluntarily or as

orders or traveler’s checks shall only be required

required by 31 CFR 1022.320, may not notify

to report a transaction or a pattern of transactions

Electronic Computing Center-Detroit

any person involved in the transaction that the

that involves or aggregates funds or other assets of

ATTN: SAR-MSB

transaction has been reported.

at least $5,000.

P.O. Box 33117

2. File a SAR-MSB no later than 30 calendar

Detroit, MI 48232-5980

Notification Required

days after the date of initial detection of facts that

3. While all items should be completed fully

constitute a basis for filing the report.

and accurately, items marked with an asterisk (*)

In situations involving suspicious transactions

3. The Bank Secrecy Act requires that each

must be completed according to the provisions of

requiring immediate attention, such as ongoing

paragraph 4 below.

money laundering schemes, a money transmitter;

financial institution (including a money services

a currency dealer or exchanger; or an issuer, seller,

business) file currency transaction reports (CTRs)

4. If the information for a item marked with a

or redeemer of money orders and/or traveler’s

in accordance with the Department of the Treasury

asterisk (*) is not known or not applicable, enter

checks shall immediately notify, by telephone,

implementing regulations (31 CFR Chapter X).

special response “XX” to complete the item. To

an appropriate law enforcement authority. In

These regulations require a financial institution

indicate “Total amount” as unknown, check the

addition, a timely SAR-MSB form shall be filed,

to file a CTR (FinCEN Form 104) whenever a

box provided. Non-asterisk fields should be left

including recording any such notification in Part

currency transaction exceeds $10,000. If a

blank if the information is unknown or not

VI on the form.

currency transaction exceeds $10,000 and is

applicable.

suspicious, a money transmitter, or issuer, seller

5. Complete each suspicious activity report by

or redeemer of money orders and/or traveler’s

A. When To FileA Report:

checks or currency dealer or exchanger must

providing as much information as possible on initial

and amended or corrected reports.

file two forms, a CTR to report the currency

1. Money transmitters; currency dealers and

transaction and a SAR-MSB to report the

6. Do not include supporting documents when

suspicious aspects of the transaction. If the

exchangers; and issuers, sellers and redeemers

suspicious activity involves a currency

filing the suspicious activity report . Retain a copy

of money orders and/or traveler’s checks that are

transaction that is $10,000 or less, the institution

of the suspicious activity report and all supporting

subject to the requirements of the Bank Secrecy

is only required to file a SAR-MSB. Appropriate

documentation or business record equivalent in

Act and its implementing regulations (31 CFR

records must be maintained in each case. See

your files for five (5) years from the date of the

Chapter X are required to file a suspicious

31 CFR Chapter X.

report. All supporting documentation (such as

activity report (SAR-MSB) with respect to:

copies of instruments; receipts; sale, transaction

a. Any transaction conducted or attempted

B. Abbreviations and Definitions

or clearing records; photographs, surveillance

by, at, or through a money services business

audio and/or video recording medium) must be

1. EIN -- Employer Identification Number

made available to appropriate authorities upon

involving or aggregating funds or other assets of

request.

at least $2,000 (except as described in section

2. IRS -- Internal Revenue Service

“b” below) when the money services business

3. ITIN -- Individual Taxpayer Identification

knows, suspects, or has reason to suspect that:

Number

Catalog No. 35084Y

Rev. 3/1/11