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Financial Institutions (Anti-Money Laundering) Guidelines of 2000

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SCHEDULE (regulation (13)(1))<br />

REPORT ON FRAUDS AND LOSSES<br />

(Name <strong>of</strong> <strong>Financial</strong> Institution)<br />

For quarter ending ................ .............................<br />

(Amounts to the nearest thousand)<br />

Date<br />

I. Actual<br />

Persons involved Amount Brief Description <strong>of</strong> Fraud/Loss<br />

II. Attempted<br />

Certified Correct:<br />

Name Signature Position Date

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