BSA/AML Examiner School Case Study

Monetary Instruments log

Main

December

Branch

Calendar Month

PART I —Deposit Account Holder Information to be Log _________________________________ Purchaser's Name:_______________________________ Account Number ____________________ Wyett James Monroe 639451280

12-15-2015

Date Of Purchase:

Type of Instrument Purchased

Serial Number

Amt. Purchased in Currency

Official Check

3362

$4,361.00

____

Method us to verify account holder status of Identity ____________________________ _ Specific Document used to verify Identity_____ Drivers License

TN DL #M2362N231

PART II — Non - Depositor Accountholder Information to be Logged

Purchaser's Name and Address

Social Security Number ___________________ Date of Birth_____________________

Alien ID Number

Date of Purchase

Type of Instrument Purchased

Serial Number

Amt. Purchased in Currency

Payee on Instruments Purchased:

Amount of Purchase in Currency: Specific Document Used to Verify Identity

PART III-Third Party Information to be Logged

Is this Transaction on behalf of a third party?

Yes

No

Third Party's Name: ________________________ Account Number _____________________ If the third party is not an accountholder: Address __________________________ Social Security Number ________________________ Alien ID Number Taxpayer ID Number Prepared By_____________________________Approved By _________________________ Name Date Name Date Central Review: Name Date Julie Collins