Compliance report response form

Introduction

If you believe you are not required to lodge a compliance report for the 2012 reporting period
(1 January 2012 to 31 December 2012), OR if you are already meeting your compliance report obligations, then please complete this form if you enrolled with AUSTRAC. If you have enrolled with AUSTRAC please contact the AUSTRAC Help Desk on 1300 021 037 (a local call within Australia), or email help_desk@austrac.gov.au, as you are no longer required to complete this form.

* Organisation/person legal 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 is not required to lodge a compliance report for the 2012 reporting period (1 January 2012 to 31 December 2012) because we (tick the most applicable):

are not a reporting entity as no designated service is provided.

are a reporting entity, but did not provide a designated service within the 2012 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: even if you sold the business in 2012, if you provided a designated service during any part of 2012 you still need to provide a 2012 AML/CTF compliance report.

sold the business during 2012.

Date of sale:

Contact details of new owner:

Please note: even if you ceased business in 2012, if you provided a designated service during any part of 2012 you still need to provide a 2012 AML/CTF compliance report.

ceased business during 2012.

Date business ceased:

Please note: even if you merged the business in 2012, if you provided a designated service during any part of 2012 you still need to provide a 2012 AML/CTF compliance report.

merged or were acquired by another business during 2012.

Date of merger/acquisition:

Contact details of controlling entity:

have already lodged an AML/CTF compliance report for 2012 (AUSTRAC Business Account Number must be included).

AUSTRAC Business Number: