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TS&J BANK ANNUAL – BSA CTR EXEMPTION REVIEW FORM

Company Name Hubby’s Inc. Tax ID Number 47-8787837 Address 125 NE Hollow DR, Eagle NE 68007 Nature of Business Convenience Store DBA:

PHASE I EXEMPTION

Government Entity

Regulated Financial Institution

Public School

* Company is listed on the following stock exchange:

NYSE

NASDAQ

AMEX Symbol

listed on

NYSE

NASDAQ

AMEX Symbol

* Subsidiary of Explain ownership:

* Attach copy of proof from website: http://online.wsj.com/public/us Phase I Exemption Checklist

Confirm Customer Still Active Confirm Customer Still Listed

or Gov / Financial / School

PHASE II EXEMPTION 1. Has U.S. customer maintained transaction account with the bank for at least 2 months? X Yes No (STOP, customer is ineligible for exemption unless a risk-based analysis is conducted) 2. Does customer frequently engage in currency transactions over $10,000 (at least 5 times per year)? – 60 in 2022 X Yes No (STOP, customer is ineligible for exemption) 3. Is the U.S. customer a registered MSB (Money Service Business)? MSB List X No Yes If yes – is registration current: No Yes If Yes - Review customer History / Activity / Risk Rating to determine if exemption should be maintained. No Yes 4. Does business engage primarily in one or more of the following activities? X No Yes (STOP, customer is ineligible for exemption, check each activity that applies to this customer) Serving as financial institutions or agents of financial institutions of any type The purchase or sale to customers of motor vehicles of any kind, vessels, aircraft, farm equipment or mobile home The practice of law, accountancy, or medicine The auctioning of goods Chartering or operation or ships, buses or aircraft Pawn brokerage Gaming of any kind (other than licensed pari-mutuel betting trace tracks) Investment advisory services or investment banking services Real estate brokerage Title insurance and real estate closings Engaging in trade union activities

Phase II Exemption Checklist 5. Update Exemption Listing Spreadsheet.

60 in 2022

6. Update Suspicious Tracking.

Completed by: Ruby Rose

Date 1/31/2023

© Compliance Alliance 2011

TS&J BANK

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