2013 AML/CTF compliance report response form

11-DEC-2013

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

  • you are a reporting entity that only provides an item 31 and/or 32 designated service
  • you are a remittance network provider that only provides an item 32A designated service
  • you are a reporting entity that only provides an item 54 designated service
  • you are a reporting entity that is a member of a designated business group and another member of the group fulfils the compliance reporting obligations for the group
  • you did not provide a designated service in the 2013 reporting period (1 January to 31 December 2013).

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 Help Desk on 1300 021 037 (a local call within Australia) or email help_desk@austrac.gov.au.

If none of the paragraphs above apply to you or your business - you must complete a 2013 AML/CTF Compliance Report form, available by logging in to your AUSTRAC Online account.


*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 2013 reporting period (1 January 2013 to 31 December 2013) because we (tick the most applicable):

are not a reporting entity because no designated service was provided in the 2013 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 2013 reporting period.
hold an Australian financial services (AFS) licence and the only designated service provided was to make arrangements for a person to receive another designated service.
Please note: if you sold the business in 2013 but provided a designated service during that year you need to provide a 2013 AML/CTF compliance report.

sold the business during 2013 and have submitted a request to be removed from the Reporting Entities Roll.

Date of sale:

Contact details of new owner:

Please note: if you sold the business in 2013 but provided a designated service during that year you need to provide a 2013 AML/CTF compliance report.

ceased business during 2013 and have submitted a request to be removed from the Reporting Entities Roll.

Date business ceased:

Please note: if the business was merged or acquired by another business in 2013 but provided a designated service during 2013 you need to provide a 2013 AML/CTF compliance report.

merged or were acquired by another business during 2013.

Date of merger/acquisition:

Contact details of controlling entity:

have already lodged an AML/CTF compliance report for 2013 (AUSTRAC Account Number must be included).

AUSTRAC Account Number:

are a member of the following designated business group and another member of the group has lodged the group's 2013 AML/CTF compliance report:


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.

 

11-DEC-2013

Last modified: ...

 

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