Appendix 1 REPORTING TEMPLATEF1

This information is to be provided to:

[Name of NCB; contact details for queries; address]

Cash handler’s name:

Headquarter address:

Zip/postal code:

City:

Street:

Type of company:

• Credit institution

• Bureau de change

• Cash in transit company which is not a payment institution

• Trader (retailer)

• Casino

• Other, including payment institutions where not already categorised as one of the above (specify)

Contact persons:

Names:

Telephone Nos:

Telefax Nos:

Email addresses:

Outsourcing partner (if relevant)

Name:

Address:

Zip/postal code:

City: