Monetary Instrument Sales Log

BSA-compliant log for recording cash sales of monetary instruments (cashier's checks, money orders, traveler's checks) between $3,000 and $10,000 per 31 CFR § 1010.415.

Submission Notice

• I understand this record is required by 31 CFR § 1010.415 and must be retained for five years.

Transaction Details

• Date of Transaction
• Time of Transaction
• Branch / Location
• Total Cash Amount Tendered (USD)
  Enter the total cash received. Must be between $3,000.00 and $10,000.00 to require this log.
• Type of Monetary Instrument Sold
• If 'Other', specify instrument type
• Instrument Serial / Check Number
• Face Amount of Instrument (USD)
  The dollar amount printed on the instrument.
• Instrument Made Payable To (Payee Name)

Purchaser Identity

• Purchaser Full Legal Name
• Purchaser Date of Birth
  Required to verify identity per CIP (31 CFR § 1020.220).
• Purchaser Street Address
• City, State, ZIP
• Government-Issued ID Type Presented
• ID Number
  Record the ID number as it appears on the document.
• ID Issuing State or Country
• ID Expiration Date
  Confirm ID is not expired at time of transaction.
• Is the purchaser an existing account holder?
• Account Number (last 4 digits only)

Suspicious Activity Screening

• Did the purchaser appear to structure the transaction to avoid the $10,000 CTR threshold (e.g., multiple transactions just below $10,000)?
• Did the purchaser indicate the instrument is for a third party not present?
• If yes, name of third party on whose behalf the purchase is made
• Any other unusual behavior or red flags observed? (Optional)

Teller Verification

• Teller Full Name
• Teller Employee ID
• I certify that I personally verified the purchaser's government-issued photo ID, that the information recorded is accurate to the best of my knowledge, and that this log is submitted in compliance with 31 CFR § 1010.415.
• Flag for Supervisor / BSA Officer Review
  Select 'Yes' if any suspicious activity indicator above was answered 'Yes' or if you have any other concern.
• Additional Notes for BSA Officer (Optional)