Download:
pdf |
pdfRegistration of Money
Services Business
FinCEN Form 107
Effective January, 2008
Please type or print. Always complete entire report.
See instructions for items marked with an asterisk ( * ).
Previous editions will not be accepted after July 31, 2008.
OMB No.1506-0013
Complete and send to: Enterprise Computing Center-Detroit, Attn: Money Services Business Registration, P. O. Box 33116, Detroit, MI 48232-0116
Part I
Filing Information
1 Indicate the type of filing by checking a, b, or d below (Check only one). If filing a correction, check “c” and either a, b, or d.
a
Initial registration
b
Renewal
c
Correcting a prior filing
d
Re-registration
2 If you checked item 1 d please indicate the reason(s). Check all that apply.
a
Re-registered under state law
Part II
b
More than 10 percent transfer of equity interest
c
More than 50 percent increase in agents
Registrant Information
*3 Legal name of the money services business
4 Doing business as
*7 State 8 ZIP Code
*6 City
*5 Address
___
___
___
___
___
___
___
___
11 E-mail address (If available)
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
Part III
10 Telephone number (include area code)
___
___
*9 EIN (entity), SSN/ITIN (individual)
Owner or Controlling Person
14 Middle initial
13 First name
12 Individual’s last name, or organization’s name
15 Address
17 State
16 City
___
___
___
___
___
___
___
22 SSN/ITIN (individual), EIN (entity)
21 Date of birth
___
___
___
___
___
YYYY
___
DD
___
MM
___
__________ / __________ / __________
___
___
___
___
___
___
___
___
___
___
)
___
___
___
20 Telephone number - (include area code)
(
19 Country (if other than US)
18 ZIP Code
23 Skip this item if you completed item 22.
If the owner or controlling person is an individual enter their form of identification, the ID number, and the issuing state or country.
a
b
Passport
c
Alien registration
d
___
___
___
___
___
___
___
___
___
___
___
___
___
___
Part IV
___
ID number
___
e
Driver’s license/state ID
f
Other _________________________
Issuing state or country
Money Services and Product Information
24 States and/or territories where the registrant, its agents or branches are located. Check as many as apply. If you check either “All States” or
“All States & Territories”, do not check any other boxes.
a
b
All States & Territories
District of Columbia (DC)
Maine (ME)
New Mexico (NM)
South Dakota (SD)
All States
Florida (FL)
Maryland (MD)
New York (NY)
Tennessee (TN)
Georgia (GA)
Massachusetts (MA)
North Carolina (NC)
Texas (TX)
Alabama (AL)
Guam (GU)
Michigan (MI)
North Dakota (ND)
Utah (UT)
Alaska (AK)
Hawaii (HI)
Minnesota (MN)
N. Mariana Isls. (MP)
Vermont (VT)
American Somoa (AS)
Idaho (ID)
Mississippi (MS)
Ohio (OH)
Virgin Islands (VI)
Arizona (AZ)
Illinois (IL)
Missouri (MO)
Oklahoma (OK)
Virginia (VA)
Arkansas (AR)
Indiana (IN)
Montana (MT)
Oregon (OR)
Washington (WA)
California (CA)
Iowa (IA)
Nebraska (NE)
Pennsylvania (PA)
West Virginia (WV
Colorado (CO)
Kansas (KS)
Nevada (NV)
Puerto Rico (PR)
Wisconsin (WI)
Connecticut (CT)
Kentucky (KY)
New Hampshire (NH)
Rhode Island (RI)
Wyoming (WY)
Delaware (DE)
Louisiana (LA)
New Jersey (NJ)
South Carolina (SC)
Catalog Number 39578N
Rev. 1/08
Part IV
2
(continued)
___
___
___
___
___
25 Enter the number of branches of the registrant. Reminder: do not separately register each branch.
See instructions for an explanation of the term “branch”.
26 Money services business activities of the registrant. Check as many as apply. See instructions for an explanation of the terms ” issuer”,
“seller”, “redeemer”, “check casher”, and “money transmitter”.
a
Issuer of traveler’s checks
d
Issuer of money orders
g
Currency dealer or exchanger
b
Seller of traveler’s checks
e
Seller of money orders
h
Check casher
c
Redeemer of traveler’s checks
f
Redeemer of money orders
i
Money transmitter
27 Is any part of the registrant’s money services business an informal value transfer system?
See the explanation of “money transmitter” in the instructions.
28 Is any part of the registrant’s money services business conducted as a mobile operation?
a
Yes
b
No
a
Yes
b
No
29 Enter the number of agents authorized to conduct each money services business activity. Do not include branches, or persons who are
solely employees. See instructions for an explanation of the term “agent”.
___
___
___
___
___
___
___
___
___
___
___
___
___
___
30
___
___
___
___
Part V
___
___
___
___
Money order redemption
___
___
___
___
d
g Money transmission
___
___
___
Money order sales
f Check cashing
___
___
___
c
e Currency exchange
or dealer
___
___
b Traveler’s check redemption
___
a Traveler’s check sales
Primary Transaction Account for MSB Activities
If the registrant has more than one transaction account for money services business activities check here.
See instructions for an explanation of the term “transaction account”.
The registrant’s primary transaction account is the one that has the greatest annual dollar amount of money services business activity.
In items 30 through 35 enter information about the registrant’s primary transaction account for money services business activities.
31 Name of financial institution where the primary transaction account is held
33 City
32 Address
34 State
36 Primary transaction account number
35 ZIP Code
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
Location of Supporting Documentation
If the supporting documentation is kept at the U.S. location reported in Part II check here
37
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
Part VI
and continue to Part VII.
Address
39 State
38 City
___
___
___
___
Part VII
40 ZIP Code
Authorized Signature
I am authorized to file this form on behalf of the money services business listed in Part II. I declare that the information provided is true, correct and
complete. I understand that the money services business listed in Part II is subject to the Bank Secrecy Act and its implementing regulations. See 31
CFR Part 103. The money services business listed in Part II maintains a current list of all agents, an estimate of its business volume in the coming
year, and all other information required to comply with 31 U.S.C. 5330 and the regulations thereunder. The signature of the owner, controlling
person or authorized corporate officer is mandatory.
41 Signature
42 Print name
43 Title
44 Date of signature
______ / _____ / _______
MM
DD
YYYY
Rev. 1/08
FinCEN Form 107a
General Information
Registration of Money Services Business Instructions
Who Must Register
Generally each money services business must
register with the Department of the Treasury. This
form must be used by a money services business
(also referred to as an MSB) to register. However,
not all MSBs are required to register. For example,
if you are an MSB solely because you are an agent
of another MSB, you are not required to register.
The discussion below will help you determine
whether or not you are an MSB that is required to
register. For more information visit www.msb.gov.
The term money services business includes:
1. Currency dealers or exchangers who exchange
more than $1,000 for any one customer on any
day.
2. Check cashers who cash checks totaling more
than $1,000 for any one customer on any day.
3. Issuers of traveler’s checks, money orders or
stored value who issue more than $1,000 in
traveler’s checks, money orders or stored value
for any one customer on any day.
4. Sellers of traveler’s checks, money orders or
stored value who sell more than $1,000 in traveler’s
checks, money orders or stored value for any one
customer on any day.
5. Redeemers of traveler’s checks, money orders
or stored value who redeem more than $1,000 in
traveler’s checks, money orders or stored value
for any one customer on any day.
6. Money transmitters.
7. U.S. Postal Service.
The following are not required to register:
1. A business that is an MSB solely because it serves
as an agent of another MSB. For example, a
supermarket corporation that sells money orders
for an issuer of money orders is not required to
register. This is true even if the supermarket
corporation serves as an agent for two or more
MSBs. However, an MSB that serves as an agent of
another MSB and engages in MSB activities on its
own behalf must register. For example, a
supermarket corporation must register if, in addition
to acting as an agent of the money order issuer, it
provides check cashing or currency exchange
services on its own behalf in an amount greater
than $1,000 for any one person on any day.
2. The United States Postal Service, any agency of
the United States, of any state, or of any political
subdivision of any state.
3. At this time, persons are not required to register
to the extent that they issue, sell or redeem stored
value. If, however, a money services business
provides money services in addition to stored
value, the provision of stored value services does
not relieve it of the responsibility to register, if
required, as a provider of those other services.
For the regulatory definition of “money services
business” see 31 CFR 103.11(n) and (uu).
The following terms are used in the form and
instructions to describe a money services business:
1. An “agent” is a separate business entity from the
issuer that the issuer authorizes, through written
agreement or otherwise, to sell its instruments or,
in the case of funds transmission, to sell its send
and receive transfer services. A person who is
solely an employee of the MSB is not an agent of
that MSB.
2. A “branch” is an owned location of either an
issuer or agent at which financial services are sold.
An MSB should not separately register each of its
branches. A mobile operation owned by an MSB is
a branch of that MSB. The MSB’s headquarters is
not a branch. If the MSB has only one location,
that location is not a branch.
3. A “check casher” is a person engaged in the
business of providing cash to persons in return for
a check.
1
9. A “redeemer” is a business that accepts
instruments in exchange for currency or other
instruments for which it is not the issuer. You are
not a redeemer if you take the instruments in
exchange for goods or general services, provided
that the amount of cash returned is not more than
$1,000 for any one customer on any day.
10. A “seller” is a business that issuers authorize,
through written agreement or otherwise, to sell
their instruments or their send and receive transfer
services.
11. A “transaction account” is a deposit or account
on which the depositor or account holder is
permitted to make withdrawals by negotiable or
transferable instrument, payment orders of
withdrawal, telephone transfers, or other similar items
for the purpose of making payments or transfers to
third persons or others. Such terms include demand
deposits, negotiable order of withdrawal accounts,
savings deposit subject to automatic transfers, and
share draft accounts. See 12 USC 461(b)(1)(c).
When to Register
Initial registration: File the form within 180 days
after the date the business is established.
5. “Informal value transfer system”. See explanation
of the term money transmitter.
Renewal: Each MSB must renew its registration
every two years, on or before December 31. See
31 CFR 103.41(b)(2).
For example, if an MSB
registered on October 15, 2003, it must file a
renewal by December 31, 2004, and then every
24 months thereafter (on or before December 31,
2006, then December 31, 2008, etc.).
6. An “issuer” is the business that is ultimately
responsible for payment of money orders or
travelers checks as the drawer of such instruments,
or a money transmitter that has the obligation to
guarantee payment of a money transfer.
Correction: Use the form to correct a prior report.
Complete Part I in its entirety and only those other
entries that are being added or changed. Staple a
copy of the prior report (or the acknowledgement
from ECC-D if received) to the corrected report.
7. A “money transmitter” is a person that engages
as a business in the transfer of funds through a
financial institution.
Generally, acceptance and transmission of funds as
an integral part of the execution and settlement of
a transaction other than the funds transmission itself
(for example, in connection with the bona fide
sale of securities) will not cause a person to be a
money transmitter.
An “informal value transfer system” is a kind of
money transmitter. An informal value transfer
system includes any person who engages as a
business in an informal money transfer system or
any network of people who engage as a business in
facilitating the transfer of money domestically or
internationally outside of the conventional financial
institutions system.
8. A “person” is an individual, a corporation, a
partnership, a trust or estate, a joint stock company,
an association, a syndicate, joint venture, or other
unincorporated organization or group, an Indian
Tribe (as that term is defined in the Indian Gaming
Regulatory Act), and all entities cognizable as legal
personalities.
Re-registration: Refile a new registration form
when one of the following events occurs:
1. a change in ownership requiring re-registration
under state registration law;
2. more than 10 percent of voting power or equity
interest is transferred (except certain publiclytraded companies) or;
3. the number of agents increases by more than 50
percent.
4. A “currency dealer or exchanger” is a person
who engages in the physical exchange of currency
for retail customers.
Where to Register
Send your completed form to:
Enterprise Computing Center - Detroit
Attn: Money Services Business Registration
P.O. Box 33116
Detroit, MI 48232-0116
The Enterprise Computing Center-Detroit (ECCD) will send an acknowledgement of receipt to the
registrant listed in Part II within approximately 60
days after the form is processed (See note below).
ECC-D can respond to general questions over the
phone at telephone (800) 800-2877.
FinCEN Form 107
General Instructions
Registration of Money Services Business Instructions
NOTE: All items on FinCEN Form 107 should be
completed fully and accurately. Items marked
with an asterisk (*) must be completed for the
registration to be accepted, processed, and
recorded. Acknowledgement letters will not be
provided if these items are not complete.
1. This form is available on the Financial Crimes
Enforcement Network’s web site for MSBs at
www.msb.gov, or FinCEN’s web site at
www.fincen.gov, or by calling the IRS Forms
Distribution Center at (800) 829-2437.
2. Unless there is a specific instruction to the
contrary, leave blank any items that do not apply or
for which information is not available.
3. Complete the form by providing as much
information as possible.
4. Do not include supporting documents with this
form.
5. Type or complete the form using block written
letters.
6. Enter all dates in MM / DD / YYYY format
where MM=month, DD=day, and YYYY=year.
Precede any single number with a zero, i.e., 01,02,
etc.
7. List all U.S. telephone numbers with area code
first and then the seven-digit phone number,
using the format (XXX) XXX-XXXX.
8. Always enter an individual’s name as last name,
first name, and middle initial (if known). If a legal
entity is listed, enter its name in the last name
field.
9. Enter identifying numbers starting from left to
right. Do not include spaces, dashes, or other
punctuation. Identifying numbers include social
security number (SSN), employer identification
number (EIN), individual taxpayer identification
number (ITIN), alien registration number, driver’s
license/state identification, foreign national
identification, and passport number.
10. Enter all Post Office ZIP Codes from left to
right with at least the first five numbers, or with all
nine (ZIP + 4) if known.
11. Addresses: Enter the permanent street
address, city, two-letter state or territory
abbreviation used by the U.S. Postal Service and
ZIP Code (ZIP+4 if known) of the individual or
entity. A post office box number should not be
used for an individual, unless no other address is
available. For an individual, also enter any apartment
number, suite number, or road or route number. If
a P.O. Box is used for an entity, enter the street
name, suite number, and road or route number. If
the address of the individual or entity is in a
foreign country, enter the city, province or state,
postal code and the name of the country. Complete
any part of the address that is known, even if the
entire address is not known. If the address is in the
United States leave country code blank.
Specific Instructions
Part I Filing Information
See “When to Register” in the General Information
part of these instructions.
Item 1-- Check either box a, b, or d (only one) for
the type of filing. If this report corrects an earlier
filing, check box “c” and either box a, b, or d.
Item 2-- If you checked box 1d, please indicate
the reason by checking boxes a, b, or c (check all
that apply).
Part II Registrant Information
Item *3--Legal name of the money services
business. Enter the full legal name of the registrant
money services business as it is shown on the charter
or other document creating the entity. For example,
enter Good Hope Enterprises, Inc. when the money
services business is Good Hope Enterprises, Inc. If a
sole proprietorship, enter the business name of
the proprietorship.
Item 4-- Doing business as. If applicable, enter the
separate doing business as name of the registrant. For
example, enter in item 4, Joe’s Check Cashing,
when the money services business is Good Hope
Enterprises, Inc., d.b.a. Joe’s Check Cashing.
Items *5, *6, *7 and 8-- Address. Enter the
permanent address of the registrant.
Item *9--EIN (entity), SSN/ITIN (individual). If
the registrant is an entity enter its employer
identification number (EIN). If the registrant is an
individual and a U. S. Citizen or an alien with a
social security number, enter his/her SSN. If the
registrant is an individual who is an alien and has
an individual taxpayer identification number, enter
his/her ITIN.
Item 10-- Telephone number. Enter the telephone
number of the MSB listed in item 3.
Item 11-- E-mail address (Optional). If the MSB
has an e-mail address please enter it here. An eamil address may be used to contact the MSB should
questions arise regarding their registeration.
Part III Owner or Controlling Person
General: Any person who owns or controls a
money services business is responsibile for
registering the MSB. Only one registration form is
required for any business in any registration period.
If more than one person owns or controls the
business, they may enter into an agreement
designating one of them to register the business.
The designated owner or controlling person must
2
complete Part III and provide the requested
information. In addition, that person must sign and
date the form as indicated in Part VII. Failure by
the designated person to register the business does
not relieve any other person who owns or controls
the business of the liability for failure to register
the business.
An “Owner or Controlling Person” includes the
following:
Registrant Business
Owner or
Controlling Person
Sole Proprietorship................. the individual who
owns the business
Partnership..............................a general partner
Trust........................................ a trustee
Corporation.............................the largest single
shareholder
If two or more persons own equal numbers of
shares of a corporation, those persons may enter
into an agreement as explained above that one of
those persons may register the business.
If the owner or controlling person is a corporation, a
duly authorized officer of the owner-corporation may
execute the form on behalf of the owner-corporation.
Item 12--Individual’s last name, or organization’s
name. If the registrant is a publicly held corporation,
it is sufficient to write “public corporation” in item
11. Where registrant is a public corporation, a duly
authorized officer of the registrant must execute the
form in Part VII.
Items 13 to 22--Enter the applicable information
for the owner or controlling person. Their home
address and phone number should not be used,
unless a business address and phone number are
unavailable.
Item 23--Identification information. If you
completed item 22, you may omit this item. If you
did not complete item 22, enter separately the
form of identification, the ID number, and the
issuing state or country. Do not provide “other”
identification unless no driver’s license/state ID,
passport or alien registration number is available.
“Other” identification includes any unexpired official
identification that is issued by a governmental authority.
If you check item 23d, give a brief description of
the “other” identification.
Part IV Money Services and Product
Information
Item 24--States and/or territories where the
registrant, its agents or branches are located.
Check the box(es) for any state, territory or
district in which the money services business
offers services through its branches and/or
agents. If a service is offered on tribal lands,
mark the box for the state, territory or district
in which the tribal lands are located. If you
checked either “All States” or “All States &
Territories”, do not check any other states or
territories.
FinCEN Form 107
Registration of Money Services Business Instructions
Item 25--Enter the number of branches of the
registrant. Enter the number of branches of the
money services business at which one or more
MSB activities are offered. If there are no branches,
enter zero. See the General Information for an
explanation of the term “branch”.
Item 26--MSB activities of the registrant. Items
25a through 25i are MSB activities. Check the
box of each MSB activity conducted by the
registrant at its branches. See the General
Information for an explanation of the terms “issuer”,
“seller”, “redeemer”, “check casher”, and “money
transmitter”.
Item 27--Informal value transfer system. If any
part of the registrant’s money services business is an
informal value transfer system, check yes. An
informal value transfer system is a kind of money
transmitter. See the General Information
explanation of the term “money transmitter”.
Item 28--Mobile operation. If any part of the
registrant’s money services business is conducted
as a mobile operation, check yes. A mobile
operation is one based in a vehicle. For example,
a check cashing service offered from a truck is a
mobile operation. For purposes of Item 25, each
mobile operation should be counted as a separate
branch.
Item 29--Number of agents. Enter the number of
agents that the registrant has authorized to sell or
distribute its MSB services. Do not count branches
or any person who is solely an employee of the
MSB. A bank is not an agent for this purpose. See
the General Information for an explanation of the
term “agent”.
Part V Primary Transaction Account for
MSB Activities
Item 30--Check the box if the registrant has more
than one primary transaction account for money
services business activities. Example: If the
registrant is both an issuer of money orders and an
issuer of traveler’s checks and the registrant has
separate clearing accounts for money orders and
traveler’s checks, the box should be checked.
Item 31--Name of the financial institution where
the primary transaction account is held. Enter
the name of the bank or other financial institution
where the registrant has its primary transaction
account. If you indicated that the registrant has
more than one primary transaction account in Item
30, enter information about the account with the
greatest money service activity transaction volume
as measured by value in dollars. See the General
Information for an explanation of the term
“transaction account”.
Items 32 to 35--Enter the permanent address for
the financial institution.
Item 36--Primary transaction account number.
Enter the primary transaction account number.
Part VI
Location of Supporting
Documentation
General: The registrant must retain for five (5)
years certain information at a location within the
United States. That information includes:
1. A copy of the registration form.
2. Annual estimate of the volume of the registrant’s
business in the coming year.
3. The following information regarding ownership
or control of the business: the name and address
of any shareholder holding more than 5% of the
registrant’s stock, any general partner, any trustee,
and/or any director or officer of the business.
4. An agent list.
If the registrant has agents it must prepare and
maintain a list of its agents. That agent list must be
updated annually and retained by the business at
the location in the United States reported on this
registration form in Part II or Part VI. The agent list
should not be filed with this registration form.
The agent list must include:
a. Each agent’s name,
b. Each agent’s address,
c. Each agent’s telephone number,
d. The type of service(s) provided by each agent on
behalf of the registrant,
e. A listing of the months in the immediately
preceding 12 months in which the gross transaction
amount of each agent with respect to financial products/
services issued by the registrant exceeds $100,000,
f. The name and address of any depository
institution at which each agent maintains a transaction
account for the money services business activities
conducted by the agent on behalf of the registrant,
g. The year in which each agent first became an
agent of the registrant, and
h. The number of branches or subagents of each
agent.
Items 37 to 40--If the supporting documentation
is retained at a location other than the address
listed in Part II, enter the location information in
items 37 through 40.
Part VII Authorized Signature
Items 41 to 44--The owner or controlling person
listed in Part III must sign and date the form as
indicated in Part VII. If the owner or controlling
person is a corporation, a duly authorized officer
of the corporation must execute the form on behalf
of the corporation. Enter the date this document
was signed.
Penalties for failure to comply: Any person who
fails to comply with the requirements to register,
keep records, and/or maintain agent lists pursuant
to 31 CFR 103.41 may be liable for civil penalties
of up to $5,000 for each violation. Failure to
comply also may subject a person to criminal
penalties, which may include imprisonment for
up to five (5) years and criminal fines. See 18 USC
1960. Note: This registration does not satisfy any
state or local licensing or registration requirements.
3
Paperwork Reduction Act Notice.
The purposes of this form are to provide an effective and consistent means for money services businesses to register with the Financial Crimes Enforcement Network, and to assure maintenance of
reports or records where such reports or records
have a high degree of usefulness in criminal, tax,
or regulatory investigations or proceedings. This
report is required by law, pursuant to authority
contained in Public Law 103-305; 31 USC 5330; 5
USC 301; 31 CFR 103. The information collected
may be provided to those officers and employees
of any constituent unit of the Department of the
Treasury who have a need for the records in the
performance of their duties. The records may be
referred to any other department or agency of the
United States, to any State, or Tribal Government.
Public reporting and recordkeeping burden for this
information collection is estimated to average 30
minutes per response, and includes time to gather
and maintain data for the required report, review
the instructions, and complete the information
collection. Send comments regarding this burden
estimate, including suggestions for reducing the
burden, to the Office of Management and Budget
Paperwork Reduction Project, Washington, DC
20503 and to the Paperwork Reduction Act; Department of the Treasury, Financial Crimes Enforcement Network, P.O. Box 39, Vienna, VA 221830039. The agency may not conduct or sponsor, and
an organization (or a person) is not required to
respond to, a collection of information unless it
displays a currently valid OMB control number.
Privary Act Notice.
Pursuant to the requirements of Public Law 93579 (Privacy Act of 1974), notice is hereby given
that, in accordance with 5 U.S.C. 552a(e), the authority to collect information on FinCEN Form 107
is Public Law 103-305; 31 USC 5330; 5 USC 301;
31 CFR 103. The Department of the Treasury may
use and share the information with any other department or agency of the United States, to any
State, or Tribal Government, or part thereof, upon
the request of the head of such department or
agency, or authorized State or Tribal Government
official for use in a criminal, tax, or regulatory investigation or proceeding, and to foreign governments in accordance with an agreement, or a treaty.
Disclosure of this information is mandatory. Civil
and criminal penalties, including in certain circumstances a fine of not more than $5,000 per day
and imprisonment of not more than five years, are
provided for failure to file the form, supply information requested by the form, and for filing a false
or fraudulent form. Disclosure of the social security number or taxpayer identification number is
mandatory. The authority to collect is 31 CFR 103.
The social security number/taxpayer identification
number will be used as a means to identify the
individual or entity who files the report.
File Type | application/pdf |
File Title | MSB Registration |
Subject | MSB Registration |
Author | StephR |
File Modified | 2008-02-19 |
File Created | 2007-10-10 |