AML/CTF compliance report response form

Please complete this form if one or more of the following applies to you or your business:

  1. you are a reporting entity that only provides an item 31 and/or 32 designated service
  2. you are a remittance network provider that only provides an item 32A designated service
  3. you are a reporting entity that only provides an item 54 designated service
  4. you are a reporting entity that is licensed to operate no more than 15 electronic gaming machines and do not provide any other designated services
  5. you did not provide a designated service in the 2016 reporting period (1 January to 31 December 2016).

Please note:

  • If you or your business are no longer a reporting entity - you must submit an RE Roll Removal Request form (available in the Business Profile of your AUSTRAC Online account).
  • If you or your business have not enrolled on the Reporting Entities Roll with AUSTRAC - you need to contact the AUSTRAC Contact Centre on 1300 021 037 (a local call within Australia) or email contact@austrac.gov.au.

If none of the paragraphs above apply to you or your business - you must complete a 2016 AML/CTF compliance report form, available by logging in to your AUSTRAC Online account.

Note: If you sold the business in 2016 but provided a designated service during that year you are still required to provide a 2016 AML/CTF compliance report.


*Person:

* Business and trading names:

* AUSTRAC reference (the reference number on your letter or email, if applicable):


HINT: Type the reference exactly as it appears on your letter to ensure AUSTRAC can correctly identify you.

* Contact name and title:

* Contact phone number (include area code):

Declaration

Please select ONE of the options below and complete any additional information as prompted.

I/my business am/is not required to lodge a compliance report for the 2016 reporting period
(1 January 2016 to 31 December 2016) because we (tick the most applicable):

are not a reporting entity because no designated service was provided in the 2016 reporting period and we have submitted a request to be removed from the Reporting Entities Roll.
are a reporting entity, but did not provide a designated service in the 2016 reporting period.
hold an Australian financial services licence (AFSL) and the only designated service provided was to make arrangements for a person to receive another designated service.

sold the business during 2016 and have submitted a request to be removed from the Reporting Entities Roll.

Date of sale* (DD/MM/YYYY):

Contact details of new owner:

ceased business during 2016 and have submitted a request to be removed from the Reporting Entities Roll.

Date business ceased* (DD/MM/YYYY):

merged or were acquired by another business during 2016.

Date of merger/acquisition* (DD/MM/YYYY):

Contact details of controlling entity:

are a member of the following designated business group and another member of the group has lodged the group's 2016 AML/CTF compliance report:

Name of designated business group:

Other (please specify):

* Note: If you provided a designated service during 2016 you still need to provide an AML/CTF compliance report for that year.

I declare that:

  1. I am/have been authorised in writing to submit this form on behalf of the reporting entity; and
  2. I have updated the Reporting Entities Roll information for the reporting entity; and
  3. the information provided by me in respect of the reporting entity is true, accurate and complete.

Last modified: 22/12/2016 10:44