Cash Transaction Report — Form NP 784

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For information on how to install Adobe Reader and configure your viewing environment please see http://www.adobe.com/go/pdf_forms_configure. <!-- page break --> ## Form captions and labels (from the XFA template, in document order) - CASH TRANSACTION REPORT - Note: All fields with * are mandatory. - NP 784 - Reference No. - Form Type(hidden) - for Regulated Dealers under the Precious Stones and Precious Metals (Prevention of Money Laundering, Terrorism Financing and Proliferation Financing) Act 2019 and Pawnbrokers under the Pawnbrokers Act 2015 - Please click on 'Import XML' to import data to this form. - Import XML - Reporting Institution - Cash Transactions - Transacting Party - Person Owner - Business Owner - Declaration - Form Version - NP 784 (2/25) - CASH TRANSACTION REPORT - NP 784 - Reference No. - for Regulated Dealers under the Precious Stones and Precious Metals (Prevention of Money Laundering, Terrorism Financing and Proliferation Financing ) Act 2019 and Pawnbrokers under the Pawnbrokers Act 2015 - Reporting Institution - Cash Transactions - Transacting Party - Person Owner - Business Owner - Declaration - NP 784 (2/25) - CASH TRANSACTION REPORT - NP 784 - Reference No. - Reporting Institution - Cash Transactions - Transacting Party - Person Owner - Business Owner - Declaration - NP 784 (2/25) - CASH TRANSACTION REPORT - NP 784 - Reference No. - Reporting Institution - Cash Transactions - Transacting Party - Person Owner - Business Owner - Declaration - NP 784 (2/25) - CASH TRANSACTION REPORT - NP 784 - Reference No. - Reporting Institution - Cash Transactions - Transacting Party - Person Owner - Business Owner - Declaration - NP 784 (2/25) - CASH TRANSACTION REPORT - NP 784 - Reference No. - Reporting Institution - Cash Transactions - Transacting Party - Person Owner - Business Owner - Declaration - NP 784 (2/25) - Part I: Reporting Institution's Information - Name of Reporting Institution * - i - Registration No./ Foreign Entity Identification No. * - i - Country/ Region of Registration * - i - Address * - i - Block - Street - Building - Unit & Floor - # - - - Postal Code - City - State - Country/ Region - Reporting Institution’s Reference No. (Invoice No.) * - Name of Reporting Officer * - i - Designation * - Contact No. * - + - - - - - Fax No. - + - - - - - Email * - Part II: Details of Cash Transaction(s) - i - No. of Transaction(s): The cash transactions should all be made by a single payer and include all transactions in a single day that appear to be linked. Forms for different payers should not be combined. - Transaction Type * - Received cash from a customer - Paid cash to a customer - + - - - Transaction 1 - Cash Receipt / Payment Date * (DD/MM/YYYY) - Amount of Cash Received or Paid * (SGD or SGD equivalent) - $ - Address/Location where Transaction was made * - i - If same as transaction 1 - Block - Street - Building - Unit & Floor - # - - - Postal Code - City - State - Country/ Region - Commodity Type * - Precious Stones - Precious Metals - Precious Products - Asset-Backed Tokens - Description of Commodity Transacted * (No. of Characters (Max): 485 ) - Name of Transacting Officer * - if same as transaction 1 - Transacting Officer’s Designation * - if same as transaction 1 - Part III: Identity of the Person Who Transacted in Cash - i - is the person making the cash payment the owner of the cash? - * - Yes - No - Is the owner of the cash an individual and/or a business? If the cash owner is a separate person from the payer of cash, select "Individual" and complete Part IV. If the cash owner is a business/company, select "Business" and complete Part V. You may select both "Individual" and "Business" if you have information on both parts. - * - i - Individual - Business - Name of Person * - Nationality/ Citizenship * - Date of Birth * (DD/MM/YYYY) - Sex * - Male - Female - Contact No. * - + - - - - - Occupation * - Address - i - Block - Street - Building - Unit & Floor - # - - - Postal Code - City - State - Country/ Region - Identification Details - Identification No. * - Identification Type * - NRIC - FIN - Passport - Others - Other Identification Type - (please specify) - Country/ Region of Issue * - Expiry Date * (DD/MM/YYYY) (if applicable) - Part IV: Identity of the Person Who Owns the Cash/ Asset-Backed Token/ Commodity (if applicable) - i - No. of Owner(s): - Owner 1 - Name of Person * - Sex * - Male - Female - Contact No. * - + - - - - - Occupation * - Address - i - Block - Street - Building - Unit & Floor - # - - - Postal Code - City - State - Country/ Region - Identification Details - Identification No. * - Identification Type * - NRIC - FIN - Passport - Others - Other Identification Type * - (please specify) - Relationship of the person named in Part III to the person named above * - Family / Relative - Friend - Employee - Agent - Others - Other Relationship * - (please specify) - This section is not applicable to your selection. - Part V: Identity of the Business That Owns the Cash/ Asset-Backed Token/ Commodity (if applicable) - i - No. of Owner(s): - Owner 1 - Name of Business * - Address - i - Block - Street - Building - Unit & Floor - # - - - Postal Code - City - State - Country/ Region - Is the business a dealer in precious stones, precious metals or precious products? * - Yes - No - Business Nature * - (please specify) - Relationship of the person named in Part III to the business named above * - Employee - Agent - Others - Other Relationship * - (please specify) - Part VI: Declaration - Please click on 'Validate Form'. Form validation must be successful before it can be submitted. - Validate Form - Validation Status - I declare that the information provided in this report is full and accurate*. - Name / Signature of Reporting Officer * - i - Identification Type * - i - Identification Number of Reporting Officer * - i - Date of Declaration * - i - *It is an offence under section 27 of the Precious Stones and Precious Metals (Prevention of Money Laundering, Terrorism Financing and Proliferation Financing) Act 2019 and section 70 of the Pawnbrokers Act 2015 to provide any information that is materially false or misleading or to omit to provide any information knowing or having reason to believe that such omission will create a false or misleading impression. - ReaderRec(hidden)