SCHEDULE 3(Paragraphs 7(1)(c), 30(1)(c) and (e), 33(1)(c) and (e) and 70(1)(c), subsection 131(3) and section 152)Report with Respect to Final Receipt of Electronic Funds Transfers
PART A
Information with Respect to Electronic Funds Transfer
1
Number that identifies final receipt of electronic funds transfer
2*
Type of electronic funds transfer (SWIFT or non-SWIFT)
3*
Date on which electronic funds transfer finally received
4*
Time at which electronic funds transfer finally received
5*
Amount of funds finally received
6*
Type and amount of each fiat currency involved in final receipt
7
Exchange rates used
8
In the case of a SWIFT message, additional payment information fields required in message
9
Source of funds, if obtained in ordinary course of business
10
If obtained in ordinary course of business, name of every person or entity that is source of funds involved and their account number or policy number and name of the person or entity with which the account or policy is held or, if no account number or policy number, identifying number and name of the person or entity that issued it
11*
Following details of remittance of, or in exchange for, funds finally received:
(a)
method of remittance
(b)
if remittance is in funds, type and amount of each type of funds involved
(c)
if remittance is not in funds, type of remittance and its value, if different from amount of funds finally received
(d)
name of every person or entity involved in remittance and their account number or policy number and name of the person or entity with which the account or policy is held or, if no account number or policy number, identifying number and name of the person or entity that issued it
PART B
Account and Reference Number Information
1*
Every account number and other equivalent reference number connected to electronic funds transfer
1.1*
Name of person or entity with which the account is held or of person or entity that issued the reference number
2
Type of account
3
Branch number, institution number and similar numbers connected to account or reference number
4
Name of each account holder
5
Type of fiat currency of account
6
Date account opened
PART C
Information with Respect to Person Who Requests Initiation of Electronic Funds Transfer
1*
Person’s name
2
Person’s alias
3
Person’s date of birth
4*
Person’s address
5
Person’s country of residence
6
Person’s email address
7
Person’s telephone number
8
Nature of person’s principal business or their occupation
9
Identification number assigned to person by reporting person or entity
10
Type of document or other information used to identify person, or to verify their identity, and number of document or number associated with information
11
Jurisdiction and country of issue of document or other information
12
Name of person’s employer
13
Type of device used by person who makes request online
14
Number that identifies device
15
Internet Protocol address used by device
16
Person’s user name
17
Date and time of person’s online session in which request is made
PART D
Information with Respect to Entity That Requests Initiation of Electronic Funds Transfer
1*
Entity’s name
2*
Entity’s address
3
Entity’s telephone number
4
Nature of entity’s principal business
5
Identification number assigned to entity by reporting person or entity
6
Name of each person — up to three — who is authorized to bind entity or to act with respect to account
7
Type of document or other information used to identify entity, or to verify its identity, and number of document or number associated with information
8
Jurisdiction and country of issue of document or other information
9
Type of device used by entity that makes request online
10
Number that identifies device
11
Internet Protocol address used by device
12
Entity’s user name
13
Date and time of entity’s online session in which request is made
PART E
Information with Respect to Holder of Account From Which Funds Are Withdrawn (if Different from Person or Entity in Part C or D)
1*
Account holder’s name
2*
Account holder’s address
3
Account holder’s email address
4
Account holder’s telephone number
5
Nature of account holder’s principal business or their occupation
6
Identification number assigned to account holder by reporting person or entity
7
Type of document or other information used to identify account holder, or to verify their identity, and number of document or number associated with information
8
Jurisdiction and country of issue of document or other information
9
Relationship of account holder to person or entity that requests withdrawal of funds
10
If account holder is a person,
(a)
their alias
(b)
their date of birth
(c)
their country of residence
(d)
their employer’s name
11
If account holder is an entity,
(a)
name of each person — up to three — who is authorized to bind entity or to act with respect to account
(b)
its registration or incorporation number and jurisdiction and country of issue of that number
PART F
Information with Respect to Person or Entity on Whose Behalf Initiation of Electronic Funds Transfer Is Requested
1
Person’s or entity’s name
2
Person’s or entity’s address
3
Nature of person’s or entity’s principal business or their occupation
4
Type of document or other information used to identify person or entity, or to verify their identity, and number of document or number associated with information
5
Relationship of person or entity to person or entity that requests initiation of electronic funds transfer
6
In the case of a person, their date of birth
7
In the case of an entity, its registration or incorporation number and jurisdiction and country of issue of that number
PART G
Information with Respect to Person or Entity That Initiates Electronic Funds Transfer
1*
Person’s or entity’s name
2*
Person’s or entity’s address
3*
If person or entity is a member of SWIFT, their Bank Identification Code or Business Entity Identifier
4
Any other identification number assigned to person or entity in respect of their electronic funds transfer activities
5
Number that identifies person’s or entity’s place of business
PART H
Information with Respect to Every Person or Entity That Sends Electronic Funds Transfer Initiated by Another Person or Entity
1*
Person’s or entity’s name
2*
Person’s or entity’s address
3*
If person or entity is a member of SWIFT, their Bank Identification Code or Business Entity Identifier
4
Any other identification number assigned to person or entity in respect of their electronic funds transfer activities
5
Relationship of person or entity to person or entity that initiates electronic funds transfer
6
Relationship of person or entity to person or entity that finally receives or is to finally receive electronic funds transfer
PART I
Information with Respect to Person or Entity That Finally Receives Electronic Funds Transfer
1*
Person’s or entity’s name
2*
Person’s or entity’s address
3*
If person or entity is a member of SWIFT, their Bank Identification Code or Business Entity Identifier
4
Any other identification number assigned to person or entity in respect of their electronic funds transfer activities
5*
Type of person or entity, as described in section 5 of the Act
6*
Number that identifies place of business where person or entity finally receives electronic funds transfer
7*
Contact person’s name
8
Contact person’s email address
9*
Contact person’s telephone number
PART J
Information with Respect to Every Other Person or Entity That Is Involved in Effecting Electronic Funds Transfer That Is a SWIFT Message
1*
Person’s or entity’s name
2*
Person’s or entity’s address
3*
If person or entity is a member of SWIFT, their Bank Identification Code or Business Entity Identifier
4
Any other identification number assigned to person or entity in respect of their electronic funds transfer activities
5
Relationship of person or entity to person or entity that initiates electronic funds transfer
6
Relationship of person or entity to person or entity that sends electronic funds transfer
7
Relationship of person or entity to person or entity that finally receives electronic funds transfer
PART K
Information with Respect to Beneficiary
1*
Beneficiary’s name
2*
Beneficiary’s address
3
Beneficiary’s email address
4
Beneficiary’s telephone number
5
Nature of beneficiary’s principal business or their occupation
6
Identification number assigned to beneficiary by reporting person or entity
7*
Type of document or other information used to identify beneficiary, or to verify their identity, and number of document or number associated with information
8*
Jurisdiction and country of issue of document or other information
9
User name of beneficiary that receives payment online
10
If beneficiary is a person,
(a)
their alias
(b)
their date of birth
(c)
their country of residence
(d)
their employer’s name
11
If beneficiary is an entity,
(a)*
name of each person — up to three — who is authorized to bind entity or to act with respect to account
(b)*
its registration or incorporation number and jurisdiction and country of issue of that number
PART L
Information with Respect to Person or Entity on Whose Behalf Beneficiary Is to Receive Remittance
1*
Person’s or entity’s name
2
Person’s or entity’s address
3
Person’s or entity’s email address
4
Person’s or entity’s telephone number
5
Person’s or entity’s principal business or occupation
6
Identification number assigned to person or entity by reporting person or entity
7
Type of document or other information used to identify person or entity, or to verify their identity, and number of document or number associated with information
8
Jurisdiction and country of issue of document or other information
9*
Relationship of person or entity to beneficiary
10
In the case of a person,
(a)
their alias
(b)
their date of birth
(c)
their country of residence
(d)
their employer’s name
11
In the case of an entity,
(a)
name of each person — up to three — who is authorized to bind entity or to act with respect to account
(b)
its registration or incorporation number and jurisdiction and country of issue of that number
