International Electronic Funds Transfer Report

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1 Financial Transactions and Repts Analysis Centre of Canada Centre d analyse des opérations et déclarations financières du Canada International Electronic Funds Transfer Rept If you have the capability to rept electronically, if you have to rept a SWIFT EFT, DO NOT use this paper fm. Refer to the repting section of FINTRAC s Web site Use this fm if you are a repting entity and you have to send an electronic funds transfer (EFT) rept to FINTRAC about an incoming outgoing international EFT. An EFT is the transmission of instructions f a transfer of funds through any electronic, magnetic optical device, telephone instrument computer. F me infmation about which EFTs have to be repted and who is considered a repting entity and f instructions on how to complete this fm, see Guideline 8C: Submitting Electronic Funds Transfer Repts to FINTRAC by Paper call FINTRAC s toll-free enquiries line at Send completed fm by mail: FINTRAC, Section A, 234 Laurier Avenue West, 24th Flo, Ottawa, Ontario K1P 1H7 send completed fm by fax: Is this Rept a crection to a Rept previously submitted? NO YES 2 0 Time HOUR MINUTE through Part G REPORTING DATE 2 0 TIME HOUR MINUTE All fields of the rept marked with an asterisk (*) must be completed. The ones that are also marked if applicable must be completed if they are applicable to you the transaction being repted. F all other fields, you have to make reasonable effts to get the infmation. General infmation 1. Repting entity s full name 1A. Repting entity rept reference number Whom can FINTRAC contact about this rept? 2. Contact Surname 3. Contact Given name 4. Contact Initial/ 5. Contact Telephone number (with area code) 6. Contact Telephone extension number Is this rept about an incoming outgoing EFT? OUTGOING EFT (sent outside Canada from within Canada) INCOMING EFT (sent to Canada from outside Canada) 24-hour rule Is this rept about an EFT of less than $10,000 that is part of a group of two me such EFTs made within 24 consecutive hours of each other that total $10,000 me? NO YES If an EFT is reptable as one of multiple EFTs of less than $10,000, and because of this, infmation f any mandaty fields in the rept was not obtained at the time of the transaction (and the infmation is not available from your recds), you can leave those fields blank. Use a separate fm f each EFT that you have to rept, whether not the 24-hour rule applies. Revised March 2006

2 PART A Infmation about the transaction (when the EFT was sent) 1. Time of transaction 2. Date of transaction * HOUR MINUTES SECONDS 3. Amount of transaction * Transaction currency code * Enter CAD if Canadian dollars USD f United States dollars. If another type of currency is involved, see Appendix 1 in Guideline 3B: Submitting Suspicious Transaction Repts to FINTRAC by Paper. 5. Exchange Rate F an OUTGOING EFT, indicate the exchange rate to convert the amount sent from Canadian dollars F an INCOMING EFT, indicate the exchange rate to convert the amount sent into Canadian dollars PART B Infmation about the client dering the EFT Name of the client that dered the EFT. (If the client is an entity, complete field 1. If it is an individual, complete fields 2, 3 and 4.) 4. /Initial Address of the client dering the EFT 7. Province State 8. Country 9. Postal Zip code 10. Telephone number (with area code) Additional infmation about the client dering the EFT 11. Date of birth (if the client is an individual) 12. Occupation (if the client is an individual) 13. Client s account number * (if applicable) 14. Client s identifier (if the client is an individual) Birth certificate Driver s licence Passpt Provincial health card Recd of landing / Permanent resident card 15. Client identifier number International Electronic Funds Transfer Rept

3 PART C Infmation about the individual entity sending the payment instructions f the EFT Name of the entity individual sending the payment instructions f the EFT. (If it is an entity, complete field 1. If it is an individual, complete fields 2, 3 and 4.) 4. /Initial Address of the entity individual sending the payment instructions * * 7. Province State * 8. Country * 9. Postal Zip code * PART D Infmation about any third party related to the EFT der (if the client dering the EFT is acting on behalf of a third party) Name of the third party on whose behalf the EFT was dered. (If the third party is an entity, complete field 1. If it is an individual, complete fields 2, 3 and 4.) 1. Full name of entity 2. Surname 3. Given name 4. /Initial Address of the third party related to the EFT der 7. Province State 8. Country 9. Postal Zip code Additional infmation about the third party related to the EFT der 10. Date of birth (if the third party is an individual) 11. Occupation (if the third party is an individual) 12. Third party s identifier (if the third party is an individual) Birth certificate Driver s licence Passpt Provincial health card Recd of landing / Permanent resident card International Electronic Funds Transfer Rept

4 PART E Infmation about the individual entity receiving the payment instructions f the EFT Name of the entity individual receiving the payment instructions f the EFT. (If it is an entity, complete field 1. If it is an individual, complete fields 2, 3 and 4.) 4. /Initial Address of the entity individual receiving the payment instructions f the EFT * * 7. Province State * 8. Country * 9. Postal Zip code * PART F Infmation about the client to whose benefit payment is made Name of the client to whose benefit EFT is paid. (If the client is an entity, complete field 1. If it is an individual, complete fields 2, 3 and 4.) 4. /Initial Address of the client to whose benefit EFT is paid 7. Province State 8. Country 9. Postal Zip code 10. Telephone number (with area code) Additional infmation about the client to whose benefit EFT is paid 11. Date of birth (if the client is an individual) 12. Occupation (if the client is an individual) 13. Client s account number * (if applicable) 14. Client s identifier (if the client is an individual) Birth certificate Driver s licence Passpt Provincial health card Recd of landing / Permanent resident card International Electronic Funds Transfer Rept

5 PART G Infmation about any third party beneficiary of the EFT payment (if the client to whose benefit the payment is made is acting on behalf of a third party) Name of the third party on whose behalf the EFT was paid. (If the third party is an entity, complete field 1. If it is an individual, complete fields 2, 3 and 4.) 1. Full name of entity 2. Surname 3. Given name 4. /Initial Address of the third party on whose behalf the EFT was paid 7. Province State 8. Country 9. Postal Zip code Additional infmation about the third party on whose behalf the EFT was paid 10. Date of birth (if the third party is an individual) 11. Occupation (if the third party is an individual) 12. Third party s identifier (if the third party is an individual) Birth certificate Driver s licence Passpt Provincial health card Recd of landing / Permanent resident card The infmation on this fm is collected under the Proceeds of Crime (Money Laundering) and Terrist Financing Act (the Act). It will be used f analytical purposes and may also be used f the purposes of ensuring compliance with the Act. Any personal infmation is protected under the provisions of the Privacy Act. F me infmation, consult the Financial Transactions and Repts Analysis Centre of Canada chapter in the Sources of Federal Government Infmation publication, available on the Government of Canada Info Source Web site ( International Electronic Funds Transfer Rept

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