TD F 93.07 Report of Rejected Transactions

Reporting, Procedures and Penalties Regulations

TD-F 93.07 Reject report form (February 2019)

Reporting, Procedures and Penalties Regulations

OMB: 1505-0164

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REPORT ON REJECTED TRANSACTION*

(Use of this form is optional, but the information requested is required by 31 C.F.R. § 501.604)


Shape1 UNITED STATES DEPARTMENT OF THE TREASURY

OFFICE OF FOREIGN ASSETS CONTROL

OMB Form: TD-F 93.07

REPORTING INSTITUTION INFORMATION

INSTITUTION NAME


ADDRESS


CITY


STATE


POSTAL CODE


COUNTRY


CONTACT PERSON NAME


TITLE


TELEPHONE NUMBER


E-MAIL ADDRESS


DATE PREPARED


TRANSACTION INFORMATION

VALUE (USD)


VALUE DATE


DATE OF REJECTION


Type of Transaction (e.g., wire transfer, account, letter of credit, check, securities)


LEGAL AUTHORITY OR AUTHORITIES FOR REJECTING (e.g., 31 C.F.R Part 560)


SANCTIONS TARGET / NEXUS (e.g., sectoral sanctions target or commercial activity with Cuba, Iran, Syria, Crimea)


ORIGINATOR NAME & ADDRESS


ORIGINATING FINANCIAL INSTITUTION NAME & ADDRESS


Sender’s Correspondent (if applicable)


Receiver’s Correspondent (if applicable)


INTERMEDIARY FINANCIAL INSTITUTION NAME & ADDRESS


BENEFICIARY FINANCIAL INSTITUTION NAME & ADDRESS


BENEFICIARY NAME & ADDRESS


SENDER’S REFERENCE


BANK REFERENCE NUMBER


ORIGINATOR TO BENEFICIARY AND / OR BANK TO BANK INFORMATION



* For certain rejected transactions, some of the above fields may not be applicable. Complete all applicable fields and include all other relevant information (e.g., account number, check number, drawee bank) in the “Additional Relevant Information” field on page 2. To report blocked property, please use form “Report on Blocked Property – Tangible/Real/Other Non-financial Property”/OMB Form TD-F 93.08 or “Report on Blocked Property – Financial”/OMB Form TD-F 93.02, whichever is applicable.

PLEASE INCLUDE A COPY OF ANY PAYMENT OR TRANSFER INSTRUCTIONS OR OTHER RELEVANT DOCUMENTATION AS A SEPARATE ATTACHMENT

ADDITIONAL RELEVANT INFORMATION


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AuthorJames Kostiw
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File Created2021-01-15

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