BSA/AML Quantity of Risk Summary Form

BSA/AML Quantity of Risk Summary Form

Identifying Information:

Charter Number:

Bank Name:

Bank Contacts:
Title:
First Name:

Last
Name:

Phone:
Email:

Alternate:
First Name:

Last Name:

Phone:
Email:

OCC Contacts:
First Name:

Last Name:

Phone:
Email:

Alternate:
First Name:

Last Name:

Phone:
Email:

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Products/Services:
(Data for this section should reflect
averages for
the previous 12 months as of 9/30.)

Number of Retail
Transactions
(average daily
volume)

Average
Daily Volume
(thousands)

Estimated/
Verified

1. Issuance of Traveler's Checks, Official
Bank Checks & Money Orders:

2. International Bank Drafts:
2a. Geographical Focus:
Enter information for all applicable geographies.

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X

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3. Domestic Wires Transfers Totals:
4. Domestic PUPIDs Wire Transfers:
5. ACH:
6. Int'l Wires Transfers Totals:
6a. Geographical Focus:
Enter information for all applicable geographies.

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X

Select a Country...

7. Int'l PUPIDs Wire Transfers:
7a. Geographical Focus:
Enter information for all applicable geographies.
ADD COUNTRY

X

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8. Remittance Products:
8a. Geographical Focus:
Enter information for all applicable geographies.
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X

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9. Cross-Border ACH:
9a. Geographical Focus:
Enter information for all applicable geographies.
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X

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Products/Services:
(Data for this section should reflect all
accounts
on record at the bank as of 9/30.)

Total Number
of Accounts
(actual number)

Total Outstanding
Balances
(thousands)

Estimated/
Verified

10. Loans Secured by Cash Collateral:

11. Payroll Cards:

12. Stored Value Cards Sold by Bank:
(E-Cash, Smart Cards)

13. Special Use/Concentration Accts:

14. International Branch Facility:
14a. Geographical Focus:.
Enter information for all applicable geographies.

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X

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15. Foreign Correspondent Accts:
15a. Geographical Focus:
Enter information for all applicable geographies.
ADD COUNTRY

X

Select a Country...

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16. Payable Through Accts:
16a. Geographical Focus:
Enter information for all applicable geographies.

ADD COUNTRY
X

Select a Country...

17. Pouch Services with Foreign Institutions
Persons and/or Businesses:
17a. Geographical Focus:
Enter information for all applicable geographies.

ADD COUNTRY
X

Select a Country...

18. Foreign Banking Affiliate (e.g. Parallel Banks):
18a. Geographical Focus:
Enter information for all applicable geographies.

ADD COUNTRY
X

Select a Country...

19. International Department:
19a. Geographical Focus:
Enter information for all applicable geographies.
ADD COUNTRY

X

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20. Domestic Private Banking Customers:
21. International Private Banking Customers:
21a. Geographical Focus:
Enter information for all applicable geographies.
ADD COUNTRY

X

Select a Country...
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22. Embassy & Consulate Banking:
22a. Geographical Focus:
Enter information for all applicable geographies.

ADD COUNTRY
X

Select a Country...

Trust Department Accounts
Charitable Trust & Foundations
23. Domestic Charitable Trust & Foundations:
24. Foreign Charitable Trust & Foundations:
24a. Geographical Focus:
Enter information for all applicable geographies.

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X

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Customer Directed Accts
(non-discretionary):
25. Custodial Accts:
26. Investment Advisory Accts:
27. Revocable Trusts:

28. Foreign Grantor or Beneficiaries:
29. Loans to Closely Held Corporations:

30. Cash Management

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31. Domestic Commercial Letters of Credit:
32. International Commercial Letters of Credit::
32a. Geographical Focus:
Enter information for all applicable geographies.

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X

Select a Country...

33. Stand-By Letters of Credit:

34. Brokerage Department/Operations:

35. Investment Advisory/Mgmt:

Customers:
(Data for this section should reflect all
customers on record at the bank as of
9/30.)

Total Number
of Accounts
(actual number)

Total Outstanding
Balances
(thousands)

Estimated/
Verified

36. Non-Resident Alien Accts:
36a. Geographical Focus:
Enter information for all applicable geographies.

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X

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37. Politically Exposed Persons:
37a. Geographical Focus:
Enter information for all applicable geographies.
ADD COUNTRY

X

Select a Country...

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38. Foreign Off-Shore Corporations:
38a. Geographical Focus:
Enter information for all applicable geographies.

ADD COUNTRY
X

Select a Country...

Money Service Business (MSB)

39. Domestic Casa de Cambios/Currency
Exchange:
40. Foreign Casa de Cambios/Currency
Exchange:
40a. Geographical Focus:
Enter information for all applicable geographies.

ADD COUNTRY
X

Select a Country...
41. Money Transmitters :
42. Check Cashers:
43. Seller/Issuer/Redeemer of Traveler
checks and money orders:
44. Seller/Issuer/Redeemer of Stored Value:
(E-Cash, Smart Cards)

45. Convenience Stores:
46. Liquor Stores:

47. Customers/Accts opened through the
Internet, Mails, Wire, or Phone (non-branch):

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48. Domestic Deposit Brokers:
49. Foreign Deposit Brokers:
49a. Geographical Focus:
Enter information for all applicable geographies.

ADD COUNTRY
X

Select a Country...

50. Domestic Charitable Organizations:
51. Foreign Charitable Organizations:
51a. Geographical Focus:
Enter information for all applicable geographies.

ADD COUNTRY
X

Select a Country...

52. Jewelry, Gem, and Precious Metal Dealers:

53. Travel Agencies:

54. Casinos:

55. Import/Export:

56. Broker Dealers:

57. Telemarketers:

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58. Car Dealers:

59. Boat/Airplane:

CTR/SAR data and Optional Examiner feedback

Estimated Currency Transaction
Report (CTR) and Suspicious
Activity Report (SAR) volumes for
the previous 12 months.
(For the previous 12 months
ending 9/30)

CTR Volume (12months)

SAR Volume (12 months)

Optional: Feedback/Suggestions on
ways to improve this Risk Assessment
form, and our analysis of BSA/AML
Compliance and Reputation risk.

Please save information and email a copy of the PDF file to your OCC Supervisory Office. Save a
copy for your records.

Submission Process
To be completed by your OCC Supervisory Office.

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Template created on: 11/4/2007

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