KCCS Suspicious Transaction Report

Purpose:
This form is to be used when an employee of KCCS has reasonable grounds for having knowledge or suspicion, that another person is engaged in money laundering or that terrorist property exists.

Information about where the transaction took place.
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Information about the transaction.
Date of Transaction: Date of Transaction: / MM / DD YYYY
Time of Transaction: Time of Transaction: : HH MM AM/PM
Date of Posting: Date of Posting: / MM / DD YYYY

(if different from the date of transaction)
Detail of funds involved.

Detail of funds involved. Cash Incoming electronic funds transfer Negotiated bank draft Negotiated cheque Negotiated money order Other Other
Amount of transaction:
Type of Currency:

Type of Currency: CAD (Canadian Dollar) USD (United States Dollar)
How was the transaction conducted?

How was the transaction conducted? In office Mail Deposit Telephone Other Other
Full Names of Individuals and Staff Involved:
Last Name: First Name: Last Name: First Name: Last Name: First Name: Last Name: First Name:
Description of suspicious activity:

Provide as many details as possible to explain what you found suspicious.

KCCS Suspicious Transaction Report

KCCS Suspicious Transaction Report

Information about where the transaction took place.

Information about the transaction.