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 FZLZN/

ANTI-MONEY LAUNDERING & COMBATING FINANCING of TERRORISM
QUESTIONNAIRE FOR CORESPONDENT RELATIONSHIP

A. BASIC INFORMATION
1. Name of Institution: ____________________________________________
2. Registered Address: ____________________________________________
____________________________________________
3. Website Address: ____________________________________________
4. Principal Business Activities: ______________________________________
5. Regulatory Authority: ____________________________________________
6. Operational Status:
Does your Bank maintain a physical presence in the licensing country? Yes / No

B. OWNERSHIP / MANAGEMENT
7. Is your institution listed on any stock exchange? Yes / No
If so, which stock exchange?

___________________________________________________
8. ,I 1R WR 4 SOHDVH SURYLGH D OLVW RI WKH PDMRU VKDUHKROGHUV
holding more than 10% shares in your institution.
___________________________________________________
___________________________________________________

C. ANTI-MONEY LAUNDERING AND TERRORIST FINANCING CONTROLS

,I\RXDQVZHUQRWRDQ\TXHVWLRQDGGLWLRQDOLQIRUPDWLRQFDQEHVXSSOLHGDWWKHHQGRIthe questionnaire.
I. General AML&CFT Policies, Practices and Procedures:
9. Does your institution have in place policies and procedures approved Yes / No
E\\RXULQVWLWXWLRQVERDUGRUVHQLRUPDQDJHPHQWWR prevent Money
Laundering and Combat Financing of Terrorism?

10. Does your institution have a legal and regulatory compliance Yes / No
program that includes a designated officer that is responsible for
coordinating and overseeing the AML/CFT framework?

11. Has your institution developed written policies documenting the Yes / No
processes that they have in place to prevent, detect and report
suspicious transactions?

12. Does your institution have a policy prohibiting accounts/relationships Yes / No

with shell banks? (A shell bank is defined as a bank incorporated in a
jurisdiction in which it has no physical presence and which is
unaffiliated with a regulated financial group.)

13. Does your institution permit the opening of anonymous or numbered Yes / No
accounts by customers?

14. Does your institution have policies to reasonably ensure that they will Yes / No
not conduct transactions with or on behalf of shell banks through any
of its accounts or products?



 FZLZN/

15. Does your institution have policies covering relationships with Yes / No
3ROLWLFDOO\ ([SRVHG 3HUVRQV 3(3V WKHLU IDPLO\ DQG FORVH
associates?

16. Does your institution have policies and procedures that require Yes / No
keeping all the records related to customer identification and their
transactions?
,I<HVIRUKRZORQJ"____________________________________

II. Risk Assessment

17. Does your institution have a risk-based assessment of its customer Yes / No
base and their transactions?

18. Does your institution determine the appropriate level of enhanced Yes / No
due diligence necessary for those categories of customers and
transactions that the FI has reason to believe pose a heightened risk
of illicit activities at or through the FI?

III. Know Your Customer, Due Diligence and Enhanced Due Diligence
19. Has your institution implemented processes for the identification of Yes / No
those customers on whose behalf it maintains or operates accounts or
conducts transactions?

20. Does your institution have a requirement to collect information Yes / No

reJDUGLQJLWVFXVWRPHUVEXVLQHVVDFWLYLWLHV"

21. Does your institution have a process to review and, where Yes / No
appropriate, update customer information relating to high risk client
information?

22. Does your institution have procedures to establish a record for each Yes / No
new customer noting their respective identification documents and
.QRZ<RXU&XVWRPHULQIRUPDWLRQ"

23. Does your institution complete a risk-based assessment to understand Yes / No

the normal and expected transactions of its customers?

IV. Reportable Transactions for Prevention and Detection of ML/TF

24. Does your institution have policies or practices for the identification Yes / No
and reporting of transactions that are required to be reported to the
authorities?

25. Where cash transaction reporting is mandatory, does your institution Yes / No
have procedures to identify transactions structured to avoid such
obligations?

26. Does your institution screen customers and transactions against lists Yes / No
of persons, entities or countries issued by government/competent
authorities or under the UN security Council Resolution?



 FZLZN/

27. Does your institution have policies to reasonably ensure that it only Yes / No
operates with correspondent banks that possess licenses to operate in
their countries of origin?

IV. Transaction Monitoring

28. Does your institution have a monitoring program for unusual and Yes / No
potentially suspicious activity that covers funds transfers and
monetary instruments such as travelers checks, money orders, etc?

V. AML Training
29. Does your institution provide AML& CFT training to relevant Yes / No
employees of your organisation?

30. Does your institution communicate new AML related laws or Yes / No
changes to existing AML related policies or practices to relevant
employees?

31. Does your institution provide AML training to relevant third parties Yes / No
if they are employed to carry out some of the functions of your
organisation?

Space for additional information:

(Please indicate which question the information is referring to.)
..........................................................................................................................................................................
..........................................................................................................................................................................
..........................................................................................................................................................................
................................................................................................................................
D. GENERAL

32. Does the responses provided in this Declaration applies to the Yes / No
following entities:
x Head Office and all domestic branches
x Overseas branches
x Domestic subsidiaries
x Overseas subsidiaries

,IWKHUHVSRQVHWRDQ\RIWKHDERYHLV1RSOHDVHSURYLGHDOLVWRIWKHEUDQFKHVDQGRUVXEVLGLDULHVWKDW
are excluded, including the name of the institution, location and contact details.

I, the undersigned, confirm to the best of my knowledge that the information provided in this
questionnaire is current, accurate and representative of the anti-money laundering and anti-terrorist
financing policies and procedures that are established in my institution.
I also confirm that I am authorized to complete this questionnaire on behalf of my institution.
Signature: ____________________________________
Name: ____________________________________
Designation: ____________________________________
Date: ____________________________________
Contact No: ____________________________________
Email: ____________________________________



 FZLZN0

5752+%+17564#05#%6+104'2146
564(14/
A. Reporting Institution :
1. Name of the Bank:
2. Name of the Branch:

B. Details of Report:
1. Date of sending report:
2. Is this the addition of an earlier report? Yes No
3.If yes, mention the date of previous report

C. Suspect Account Details :

1. Account Number:
2. Name of the account:
3. Nature of the account:
(Current/savings/FDR/loan/other, pls. specify)
4. Nature of ownership:
(Individual/proprietorship/partnership/company/other, pls. specify)
5.Date of opening/Transaction:
6. Address:

D. Account holder details :

1. 1. Name of the account holder:
2. Address:
3. Profession:
4. Nationality:
5. Other account(s) number (if any):
6. Other business:
)DWKHUVQDPH
0RWKHUV1DPH
9. Date of birth:
10.Place of birth:
11.Passport No.
12.National Identification No.
13. Birth Regoistration No.
14. TIN:

2. 1. Name of the account holder:

2. Relation with the account
holder mention in sl. no. D1
3. Address:
4. Profession:
5. Nationality:
1
 FZLZN0

6. Other account(s) number(if any):

7. Other business:
)DWKHUVQDPH
0RWKHUV1DPH
10. Date of birth:
11. Place of birth:
12.Passport No.
13.National Identification No.
14. Birth Regoistration No.

15. TIN:

E. Introducer Details :
1. Name of introducer:
2. Account number:
3.Relation with account holder:
4. Address:
5. Date of opening:
6. Whether introducer is maintaining
good relation with bank

F. Reasons for considering the transaction(s) as suspicious?

(Mention summery of suspicion and consequence of events)
a. Identity of clients [To be filled by the BAMLCIO]
b. Activity in account
c. Background of client
d. Multiple accounts
e. Nature of transaction
f. Value of transaction
g. Other reason (Pls. Specify)

G. Suspicious Activity Information

Summary characterization of suspicious activity:
a. Corruption and k. murder, grievous u. terrorism or financing in terrorist
bribery physical injury activities

b. counterfeiting l. trafficking of women v. adulteration or the manufacture of

currency and children goods through infringement of title

c. Counter feiting m black marketing w. offences relating to the environment

2
 FZLZN0

deeds and .
documents
d. extortion n. smuggling of domestic x. sexual exploitation
and foreign currency

e. fraud o. Theft or robbery or y. insider trading and market

dacoity or piracy or manipulation
hijacking of aircraft

f. forgery p. human trafficking z. organized crime, and participation in

organized criminal groups

g. illegal trade of q. dowry aa. racketeering

firearms

h. illegal trade in r smuggling and bb. Other(Please

narcotic drugs, offences related to specify)
psychotropic customs and excise
substances and duties
substances causing
intoxication
i. illegal trade in stolen s. tax related offences
and other goods

j. kidnapping, illegal t. infringement of

restrain and hostage intellectual property
taking rights

H. Transaction/Attempted Transaction Details:

Sl. no. Date Amount Type*

*Cash/Transfer/Clearing/TT/etc.
Add paper if necessary

,&RXQWHU3DUWV'HWDLOV (Where Applicable)

Sl. no. Date Bank Branch Account no. Amount

J. Has the suspicious transaction/activity had a material impact on or

otherwise affected the financial soundness of the bank? Yes No

K. Has the bank taken any action in this context? If yes, give details.

3
 FZLZN0

L. Documents to be enclosed
1. Account opening form along with submitted documents
2. KYC Profile, Transaction Profile
3. Account statement for last one year
4. Supporting Voucher/correspondence mention in sl. no. H
5. Others

Signature :
(CAMLCO or authorized officer of CCU)
Name :
Designation :
Phone :
Date :

4
 FZLZN1

SUSPICIOUS TRANSACTION REPORT (STR) FORM
(WIRE TRANSFER/MOBILE FINANCIAL SERVICE)

A. Reporting Institution:
1. Name of the Institution:
2. Name of the Branch/Agent:
3. Service Place of the Branch/Agent:
4. Agent Identification / ID:(If applicable)
B. Details of Report:
1. Date of sending report:
2. Is this the addition of an earlier report? Yes No
3. If yes, mention the date of previous report
C. Suspect Details:
1. Name:
2. Address:
3. Profession/Business:
4. Nationality/Ownership status:
)DWKHUVQDPH3URSULHWRUVQDPH
0RWKHUV1DPHZKHUHQHFHVVDU\
7. Date of birth (where necessary):
8. Place of birth:
9. Passport No.
10. National Identification No.
11. Birth Regoistration No.
12. Contact Details:
Mobile No-
Email-
13. Any other important Information:
D. Suspicious Transaction/Attempted Transaction Details :
Sl. no. Date Amount Type

E. Reasons for considering the transaction(s) as unusual/suspicious?

(Mention summary of suspicion and consequence of events)

(Use separate sheet, if needed)

F. List of Documents attached with the report

Signature:
(CAMLCO or authorized officer of CCU)
Name:
Designation:
Phone No:
Date:

 FZLZN2



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