Suspicious Transaction Report
[See regulation 4(2)]
(Check appropriate box)
____ / ____ /
1) Date _______ dd/mm/yyyy
Supplemental
2) Initial Report Corrected Report Report
Part
I Reporting Financial Institution Information
3) Name of Institution
4) NIFT Code
5) Address of Financial Institution :
6) Name of Branch where transaction / activity occurred :
7) Branch Code
8) Address of Branch:
9) Primary Regulator
Other (Please
SBP SECP Specify)
Reporting Officer
10) Name
11) Designation
Fax Number(s) (Include area
12) Phone Number(s) (Include area code) 13) code)
Cell
14) Email Address 15) Number(s)
Contact for Assistance (If different from Reporting Officer)
16) Name
17) Designation
Fax Number(s) (Include area
18) Phone Number(s) (Include area code) 19) code)
Cell
20) Email Address 21) Number(s)
Part
II Suspect Information
22) Name
23) Father / Husband's name
24) Address (permanent)
25) Address (present)
26) Other Known Address
27) Phone Number(s) - Residence (Include area code)
28) Phone Number(s) - Office (Include area code)
29) Fax Number(s)
30) Cell Number(s)
31) CNIC Number
32) NIC Number (in case CNIC number is not available)
33) Any other Identification Number
34) National Tax Number (NTN), if available
35) Date of Birth: ___ /___ /______ (dd/mm/yyyy)
36) Nationality
Occupation/Type of
37) Business
38) Relationship with Financial Institution
Employ Agen Walk in
Accountholder ee t Customer
Other (Please specify)
39) Business Relation with Suspect
(if any)
40) Is Relationship Still Maintained With the Person? YES NO
___ /___
41) In Case No, Mention Date of Termination of Relationship /______ (dd/mm/yyyy)
42) Capacity in which the person is performing the transactions / acts
Compan Broke
Individual y Agent r
Other (Please specify)
43) Identities of other persons known to be involved in reported activity
Part
III Suspicious Transaction Information
44) Date of Suspicious Transaction ___ / ___ / ______ (dd/mm/yyyy)
45) Amount involved (Please Specify Currency)
46) Suspicious Transactions :
Date Amount Description of Transaction
47) Brief Narrative (Reasons for Suspicion)
(Include suspicious activity information, explanation / description and background details)
Characterization of Suspicious Transaction (i.e. nature of suspected predicate schedule
48) offence)
Has the transaction already been reported to any Law Enforcement Agency? If so, list the
49) agency
a
b
c
d
Part
IV Account Information
50) Account number (s) effected, if any
a) b) c) d)
51) Account (s) opened on (dd/mm/yyyy)
a) b) c) d)
52) Current Status of the Account(s)
a) b) c) d)
53) Purpose of account (s)
a) b) c) d)
54) Average Monthly Turnover of account (s)
a) b) c) d)
55) Aggregate Credits / Debits for last 3 Years
a) b) c) d)
56) Peak Balance(s) of last 3 Years
a) b) c) d)
57) Nature of Account (s):
Partners
Individual hip Company Trust
other (please specify)
58) Transaction Mean / Method
Remittan
Cash Cheque ce Pay Order
Credit Card Debit Deposits Fixed Deposit
Card
Online
Draft Transfer LC Transfer
Other (Please specify)
59) Copies of Following Documents are attached :
Customer Identifiocation documents / Account Opening
Form
KYC / CDD of Customer or Suspect
Other Documents obtained at the time of opening of account / relationship
Relevent documents supporting the STR
Other Relevant Information (information linked to STR or action taken by the reporting
60) entity)
(Seal & Signature of Reporting
Officer )
