Financial Crime World

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Suspicious Activity Report

Form 1A - Gaming

September, 2011 - Antigua and Barbuda

Confidential Document

Report Number: [Insert Report Number] Date of Incident: [Insert Date of Incident] Location: [Insert Location]

Summary

This Suspicious Activity Report (SAR) is filed in accordance with Section 13 of the Money Laundering (Prevention) Act, 1996 as amended, and Regulation 6(1) of the Money Laundering (Prevention) Regulations, 2007. The report concerns a suspicious activity or transaction related to gaming that has been discovered by [Name of Financial Institution].

Subject Information

  • Name: [Insert Name]
  • Date of Birth: [Insert Date of Birth]
  • Country of Registration: [Insert Country]

Transaction Details

  • Account Affected: [Insert Account Number]
  • Transaction Type: [Insert Transaction Type, e.g. deposit, withdrawal, transfer]
  • Amount: [Insert Amount]
  • Date of Transaction: [Insert Date of Transaction]

Other Relevant Information

  • The subject has been known to engage in suspicious activity in the past.
  • The transaction was made in cash and did not match the subject’s normal business pattern.

Reason for Reporting

The financial institution believes that this transaction may be related to money laundering or other criminal activities. Further investigation is necessary to determine the true nature of the transaction.

Action Taken

The financial institution has frozen the account pending further investigation.

Reporting Officer Information

  • Name: [Insert Name]
  • Title: [Insert Title]
  • Telephone Number: [Insert Telephone Number]

Confidentiality Notice

This report is a confidential document and must be treated as such. The reporting officer is prohibited from disclosing any information contained in this report to anyone, except as required by law.

Submission

The completed report was submitted to the Supervisory Authority on [Insert Date] and will be kept confidential.

Penalties for Non-Compliance

Failure to lodge or supply full and correct information as required may result in penalties under the Money Laundering (Prevention) Act, 1996 as amended.