Suspicious Matter Reporting - Manual Input Form
ALL USERS of this form:
Complete the form as thoroughly as you can, ensuring you enter your details so AML Operations can contact you if they have a query. (fields with an asterisk are mandatory). You will need to refer to the Appendix for guidance, such as a list to select from for your answer.
If using a soft copy of this form: Open the form and save as a new name before typing.
Email the completed form to This e-mail address is being protected from spambots. You need JavaScript enabled to view it for processing.
If using a Paper copy of this form: Fax the form to (02) 9995 8149 and securely store the original for 3 days in case AML Operations need to contact you.
Do NOT copy anyone in on the email or discuss this matter with your colleagues or the customer, as this may constitute ‘tipping off’. Tipping off is an offence under the AML/CTF Act.
Securely destroy the original and any electronic copies after 3 full business days.
* Part A – Details of The Matter
Details of the Person Making the Report
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Salary ID / Staff ID |
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This report relates to which Business Unit: |
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* Your Name |
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* Position / Title / Role |
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* Work Phone Number |
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* Work Email Address |
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Details of the Location where the matter was identified
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BSB (where applicable) |
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* Location Name (Agency/Broker Name) |
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* Street Address |
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* Suburb/State/Postcode |
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Details of the Services
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*Describe the Service(s) Involved. |
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*The service was: Enquired About, Requested or Provided |
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*Specify the Reason(s) for Your Suspicion from the list in the Appendix |
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* Part B – Grounds for Suspicion
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* Mandatory Grounds for Suspicion |
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Continued…
Part C – Details of Suspicious Customer
The purpose of this section is to capture the details of the customer you have formed a suspicion about. A customer may be a person or a company/Organisation. Fields marked with an asterisk (*) are mandatory and MUST be completed. Copy if more customers need to be added.
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Customer ID |
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Customer of: |
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* Customer Full Name |
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* Street Address (Not |
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* Suburb/State/Postcode |
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Occupation/Industry |
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Date of Birth |
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Business or Trading Names |
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ABN/ACN/ARBN |
(indicate which) |
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* ID type |
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* ID Issuer |
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* ID Number |
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* Issue Date |
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* Expiry date |
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* Country of Issue |
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Account Name in Full |
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BSB |
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Account Number |
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Account Type |
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Bank Name |
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Country |
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Part D – Details of Other Customer and/or Agent
The purpose of this section is to capture the details of any customer you believe may be the target of a crime or otherwise involved in the matter, but not the suspicious party.
This section is also used to capture the details of any agent who may or may not be suspicious. A customer or Agent may be a person or an Organisation where they are acting on another customer’s behalf. Copy to add more customers or agents as needed.
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Customer ID |
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Customer of: |
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* Customer Full Name |
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* Street Address (Not |
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* Suburb/State/Postcode |
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Occupation/Industry |
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Date of Birth |
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Business or Trading Names |
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ABN/ACN/ARBN |
(indicate which) |
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* ID type |
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* ID Issuer |
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* ID Number |
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* Issue Date |
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* Expiry date |
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* Country of Issue |
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Account Name in Full |
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BSB |
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Account Number |
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Account Type |
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Bank Name |
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Country |
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*Is Person an Agent? |
Yes or No |
*Is the agent suspicious |
Yes or No |
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*Relationship Of Agent |
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*What EVIDENCE if any, has been provided to authorise the agent’s activity? |
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Part E – Unidentified Entity
The purpose of this section is to describe any person(s) whose identity could not be established and to describe any documentation you may hold on that person.
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Describe the Person you were not able to identify |
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Supporting Information |
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Part F – Details of Transaction
This section requires you to record the details of each transaction related to the suspicious matter. You must fill out as much of this section as you can. Fields marked with an asterisk (*) are mandatory. If more than one transaction, copy for each additional transaction involved.
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* Transaction Date (even if not completed) |
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* Was the Txn Completed? |
Yes or No |
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*Txn Type (Deposit, Payment, etc) |
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* Txn Ref Number |
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* AUD Total of Txn |
AUD$ |
*AUD Total CASH (Cash Included in Total) |
AUD$ |
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Foreign Currency |
Currency Code |
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Foreign Amt |
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Currency Code |
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Foreign Amt |
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* Details of Sender/Drawer/Issuer (Sender)
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Is the sender listed in |
Yes or No |
If Yes, just enter sender institution details below if known/if applicable. |
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Is the sender listed in |
Yes or No |
If Yes, just enter sender institution details below if known/if applicable. |
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None of the above |
If not in Part C or Part D, complete All of the details below |
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Sender Full Name |
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Sender Full Address |
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Account Name in Full |
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Account Type |
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Branch |
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BSB |
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Account Number |
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Bank Name |
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Country |
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* Details of Recipient/Beneficiary/Payee (Recipient)
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Is the recupient listed in |
Yes or No |
If Yes, enter recipient institution details if known/if applicable |
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Is the recipient listed in Part D Other Party/Agent |
Yes or No |
If Yes, enter recipient institution details if known/if applicable |
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None of the above |
If not in Part C or Part D, complete All of the details below |
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Payee Name in Full |
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Beneficiary Name in Full (If Different From Payee) |
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Recipient Address in Full |
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Account Name in Full |
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Account Type |
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BSB |
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Account Number |
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Bank Name |
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Country |
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Important Remember that you MUST NOT talk to the customer or any person (other than your manager or AML Operations) about this report and your suspicions, or make any of those persons aware of your concerns. |
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[End of Form]
Appendix: Instructions for Completing the Form
Part A: Details of the Matter
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To Describe the Service Provided or Requested or Enquired About, |
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Account/Deposit Taking (for deposits, withdrawals, bank cheque purchase/buy-back, bank drafts, etc) |
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Cheque Book Access (new cheque facility, cashing cheque, etc) |
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Currency Exchange (for foreign currency purchase or encashment or new for old AUD notes & coins) |
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Custodial/Depository Services (new product/service or transactions on related products/services) |
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Debit Card Access (new/replacement debit card, deposits to or withdrawals from debit card) |
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Gift Cards/Stored Value Cards (purchase of card or transaction using this type of card eg top-up) |
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Leasing/Hire Purchase (new Lease or Hire Purchase arrangement, payments) |
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Life Insurance |
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Loans (new Loan, payments – excludes Leases or Hire Purchase which are listed separately) |
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Pensions/Annuities |
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Retirement Savings Account |
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Securities Market and Investments (new product/service or transactions on securities or investment products) |
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Superannuation/Approved Deposit Fund (new product/service or transactions on superannuation or ADF products) |
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Traveller’s Cheque Exchange (encashment or purchase of traveller’s cheques) |
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Other – Specify: if the service related to the matter is not listed above, describe it as clearly as possible. |
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Provide one or more Reason for Your Suspicion |
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ATM or Cheque Fraud |
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Avoiding Threshold Reporting Obligations (multiple transactions just below $10,000) |
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Corporate or Investment Fraud |
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Counterfeit Currency (any currency type) |
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Credit Card Fraud |
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Credit Facility or Loan Fraud |
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False Name or False ID or False Documents |
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Immigration Related Issue |
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Inconsistent with Customer Profile (activity, gender, apparent age) |
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Internet Fraud |
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National Security Concern (such as financing of terrorism) |
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Potential Scam (such as an email scam asking to deposit funds to an account of an unknown entity) |
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Suspected or Known Criminal |
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Suspicious Behaviour (cash deposit smells of drugs, person agitated, large cash deposit and withdrawal on same day, person seeking finance of a value not fitting their profile, etc) |
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Tax Evasion (you suspect the person/organisation is operating in a way to avoid taxation) |
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Unauthorised Account Transactions (authority to operate not available) |
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Unusual Account Activities (eg account with usually low value activity now has large value activity) |
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Unusually Large Cash Transaction (eg customer usually receives and remits funds electronically and now has a large cash deposit or withdrawal) |
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Unusually Large Foreign Exchange Transaction (eg customer usually deals in small foreign currency amounts and now has a large foreign currency purchase or encashment) |
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Unusually Large Transfer (to own account or other party account) |
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Other – Specify: if the reason is not listed above, describe it as clearly as possible. |
Part B – Grounds for Suspicion
It is essential that you enter as much information as you can in your own words about the suspicious matter, transaction or activity that has occurred. The suspicion may involve matters relating to all crimes, not just money laundering or terrorism financing. Any customers or transactions referred to under Part B should also be detailed in the appropriate related sections.
The information included here could help solve a crime or provide the authorities with vital information, no matter how small the detail.
Part C –Suspicious Party
It is essential that you provide as much information as you can about the suspicious person or organisation. Even if you think their ID or other documentation is not their own or has been tampered with, include the details of that as well. The suspicious party mentioned in Part B must be included in this section.
Part D –Other Party (not suspicious) and Agent (Suspicious or not)
Other Party: It is essential that you provide as much information as you can about the other non-suspicious person or organisation. A person or organisation in this section is likely to be the target of the crime, such as the owner an account being used by the suspicious party or the account the agent is enquiring about or transacting on.
Agent: In addition, if you have a person or entity acting in the capacity of an agent, complete as much as you can about them and indicate whether you feel the agent is the suspicious party. Even if you think their ID or other documentation is not their own or has been tampered with, include the details of that as well.
An agent is someone acting on behalf of an entity (individual or non-individual) to perform or attempt to perform a transaction or enquiry about a customer or a product or service. This includes signatories to accounts, however an owner of the account is not an agent.
Where you have added an agent of a customer in Part D, you need to add the customer as well. If the customer is deemed suspicious, enter them in Part C, if they are not suspicious, add them to Part D.
Part E – Unidentified Entity
The purpose of this section is to describe any person(s) whose identity could not be established and to describe any documentation you may hold on that person.
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Describe the Person |
Information that may help to describe a person includes: gender and age group; height (short, medium, tall); ethnicity or cultural appearance; build (slim, stocky, overweight); hair (curly, straight, colour, receding, none); facial features (broken nose, acne, glasses); voice (gruff, accents, speech impediment); clothing, shoes, jewellery and accessories (including handbags or ringtones); body markings (piercings, tattoos, scars); walking style (limp, strut, unusual gait); smells (perfume, alcohol, petrol, food); emotional and mental state (agitated, composed, angry, frightened).
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Supporting Information |
You may have made copies of identification documentation, or may have photos; video images such as security camera footage; recorded phone conversations; or electronic records, such as email, internet protocol (IP) address or computer logs. If no such supporting information is held, state “Not Collected”.
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Tipping Off is an Offence
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Important: Remember that you MUST NOT talk to the customer or any person (other than your manager or AML Operations) about this report and your suspicions, or make any of those persons aware of your concerns. |
