Reporting casino disbursements to FINTRAC : FINTRAC’s compliance guidance

These fields are indicated with an asterisk symbol (*) and must be completed.

Because a Casino Disbursement Report can include multiple disbursements made within 24 consecutive hours that total $10,000 or more, the information for some mandatory fields may not have been obtained at the time of the disbursement. In this case, the fields become "reasonable measures" fields, and the instructions for reasonable measures (below in this table) must be applied.

These fields are indicated with a double dagger symbol (‡) and must be completed.  

These fields are indicated with a dagger symbol (†) and must be completed if they are applicable to you or the disbursement being reported.  

You must take reasonable measures to obtain the information for all non-mandatory fields in the report, if they are applicable.

Reasonable measures are the steps that you must take, as outlined in your policies and procedures, to obtain the information that can include asking the person or entity involved in the disbursement for the information.

If you obtain the information, you must report it. You must also provide the information if it is contained within your systems or records.

Provide the first name of the person.

When entering occupation information, you should be as descriptive as possible. For example, if the person is:

• a manager, provide the area of management, such as “hotel reservations manager” or “retail clothing store manager”
• a consultant, provide the type of consulting, such as “IT consultant” or “forestry consultant”
• a professional, provide the type of profession, such as “petroleum engineer” or “family physician”
• a labourer, provide the type of labour performed, such as “road construction worker” or “landscape labourer”
• not working, you should still be as descriptive as possible, and indicate “student,” “unemployed,” “retired,” etc.

You can enter a numeric classification code and the code title in this field (for example, NOC – National Occupational Classification). However, a numeric code on its own is not sufficient as you need a written description of the occupation as explained above.

Enter the name of the person’s employer.

Do not provide the name of a supervisor or manager.

This field is meant to capture the name of the business that employs the person.

If the person has multiple employers, you only need to provide one but it should be the person’s primary employer.

Providing the name of employer can augment the description of a person’s occupation. For example, “retail clothing store manager for ABC high-end clothing store” and “retail clothing store manager for XYZ discount clothing store” are more descriptive than “retail clothing store manager” on its own.

You should be as descriptive as possible when entering the entity’s principal business.

If the entity’s principal business is “sales,” provide the type of sales, such as “pharmaceutical sales” or “retail clothing sales.”

You can enter a numeric classification code and the code title in this field (for example, NAICS – North American Industry Classification System). However, a numeric code on its own is not sufficient, as you need a written description of the nature of the entity’s principal business as explained above.

Select the identifier type for the person or entity as applicable.

If you use the dual process method to identify a person, you must provide details of both sources of information in the identifier type fields.

For more information on how to identify persons and entities, refer to:

• FINTRAC's guidance on Methods to verify the identity of persons and entities

This is the number indicated on the identifier type that was used to verify the identity of the person or entity. For example, on a driver’s licence, the licence number is the identification number and on a Certificate of Incorporation, the incorporation number is the identification number.

Provide the country, province, or state that issued the documentation used to identify the person or entity.

You must enroll in FINTRAC Web Reporting System (FWR) to submit reports electronically.

Provide the 7-digit identifier number assigned to you by FINTRAC at enrolment.

A number assigned to each report by:

• you (the reporting entity), or
• the individual or organization submitting the report on your behalf

This number must be unique to your business, meaning it can only be used once.

Indicate the type of aggregation used when multiple disbursements occur within a consecutive 24-hour period:

• Receiver
• On behalf of receiver
• Requestor
• On behalf of requestor, or
• Not applicable

If the report is for 1 disbursement only, then aggregating disbursements does not apply and you should select "Not applicable".

Provide the start date and time of the 24-hour period.

You must include the time zone (that is, UTC offset) in the 24-hour period start time field.

You must enter the start time in the following format: HH:MM:SS±ZZ:ZZ.

For example, 1:25:06 pm in Ottawa, Ontario would be reported as 13:25:06-05:00.

Provide the end date and time of the 24-hour period.

If your 24-hour period starts at 8:00 am, it would end at 7:59 am the following day.

You must include the time zone (that is, UTC offset) in the 24-hour period end time field.

The field above provides instructions for formatting.

Enter the date and time of the disbursement.

It cannot be a future date.

A report can contain multiple disbursements that took place in different time zones, but these disbursements should all be within your 24-hour aggregation period that is indicated by the 24-hour period start date and time  and the 24-hour period end date and time  in the report. 

Your process to convert and report disbursements that occur in different time zones should be documented in your policies and procedures to ensure your reporting is consistent.

For more information:

• Reporting transactions to FINTRAC: The 24-hour rule

Select the method that describes how the disbursement was requested.

If the method is not listed, select "Other."

Indicate whether the value of the disbursement made was above or below $10,000.

Select:

• "above threshold" if the disbursement is equal to $10,000 or more
• "below threshold" if it is under $10,000

This is a unique number assigned to each disbursement by:

• you (the casino), or
• the individual or organization submitting the report on your behalf 

This represents information about where the disbursement took place.

The location number is:

• created and assigned to you by FINTRAC during the enrolment process to FINTRAC Web Reporting System (FWR), and
• maintained by your FWR administrator

For more information about this, contact your FWR administrator.

Refer to Address fields under "Standardized field instructions".

Same instructions (address fields)

Same instructions (address fields)

Same instructions (address fields)

Same instructions (address fields)

Same instructions (address fields)

Same instructions (address fields)

Same instructions (address fields)

Same instructions (address fields)

Same instructions (address fields)

* Reason of disbursement

Select how the disbursement was initiated by the client.

It refers to what the client requested or presented to the casino to start the disbursement.

For example, a client requests a front cash withdrawal or requests a payment for the winnings of sports betting.

If the reason of disbursement is not in the list provided, you must select “Other” and provide the reason of disbursement.

Enter the total amount of funds involved in the starting action.
If this amount was not in Canadian dollars, do not convert it to CAD, but provide the currency type in the next field.

If the starting action was in funds, enter the currency code, including if it was in Canadian dollars.

If the currency type is not in the list provided, you must select “Other” and provide the full name of the currency.

Enter the value in Canadian dollars if the disbursement was not conducted using funds (for example, jewelry).

‡ Account category

Select the account type.

Select the type of casino account used in the disbursement:

Enter the currency code of the account, including if it was in Canadian dollars.

If the currency type is not in the list provided, you must select "Other" and provide the full name of the currency.

Enter the date the account was opened.

† Casino identifier number where the account is held

Provide the unique number assigned by FINTRAC designated for the casino.

House/Building number

Refer to Address fields under "Standardized field instructions".

Apt/Room/Suite/Unit number

Same instructions (Address fields)

† Street address

Same instructions (Address fields)

† City

Same instructions (Address fields)

District

Same instructions (Address fields)

† Province or state (code)

Same instructions (Address fields)

† Province or state (name)

Same instructions (Address fields)

Sub-province and/or sub-locality

Same instructions (Address fields)

† Country

Same instructions (Address fields)

Postal or zip code

Same instructions (Address fields)

† Surname

Refer to Name fields under "Standardized field instructions".

† Given name

Same instructions (Name fields)

Other/Initial

Same instructions (Name fields)

† Name of entity

Refer to Name fields under "Standardized field instructions".

† Account type

Select the financial institution account type.

† If "Other", please specify

If “Other” is selected, you must provide the financial institution account type.

† Financial institution number

Provide the financial institution number.

† Branch number

Provide the branch number.

† Account number

Provide the account number for the financial institution account.

† Account currency code

Enter the currency code of the account, including if it was in Canadian dollars.

If the currency type is not in the list provided, you must select “Other” and provide the full name of the currency.

Date account opened

Provide the date the account was opened.

† Surname

Refer to Name fields under "Standardized field instructions".

† Given name

Same instructions (Name fields)

Other/Initial

Same instructions (Name fields)

† Name of entity

Refer to Name fields under "Standardized field instructions".

† Reference number

If the starting action involved a reference number, provide it in this field.

Other number related to reference number

Provide any other number related to the reference number as applicable.

† Surname

Refer to Name fields under "Standardized field instructions".

† Given name

Same instructions (Name fields)

Other/Initial

Same instructions (Name fields)

Alias

Same instructions (Name fields)

Client number

Provide the client number.

It is the unique identifying number assigned by the casino to the person requesting the disbursement.

House/Building number

Refer to Address fields under "Standardized field instructions".

Apt/Room/Suite/Unit number

Same instructions (Address fields)

† Street address

Same instructions (Address fields)

† City

Same instructions (Address fields)

District

Same instructions (Address fields)

† Province or state (code)

Same instructions (Address fields)

† Province or state (name)

Same instructions (Address fields)

Sub-province and/or sub-locality

Same instructions (Address fields)

† Country

Same instructions (Address fields)

Postal or zip code

Same instructions (Address fields)

Unstructured address details

Same instructions (Address fields)

Telephone number

Refer to Telephone number fields under “Standardized field instructions”.

Extension number

Same instructions (Telephone number fields)

Email address

Provide the email address of the person.

† Date of birth

Provide the date of birth of the person.

Country of residence

Enter the primary country of residence for the person.

It can be the same or different from the country entered in the address section.

† Occupation

Refer to Occupation/business fields under "Standardized field instructions".

Name of employer

Same instructions (Occupation/business fields)

† Identifier type

Refer to Identification fields under "Standardized field instructions".

† If "Other," please specify

Same instructions (Identification fields)

† Number associated with identifier type

Same instructions (Identification fields)

† Jurisdiction of issue (country)

Same instructions (Identification fields)

† Jurisdiction of issue (province or state) (code)

Same instructions (Identification fields)

† Jurisdiction of issue (province or state) (name)

Same instructions (Identification fields)

Person’s user name

Provide the user name of the person requesting the disbursement online.

Type of device used

Select which device was used to request the disbursement online.

† If "Other," please specify

If “Other” is selected, you must provide the type of device used.

Device identifier number

Provide the device identifier number.

It is a number assigned to the device, such as:

• a Media Access Control (MAC) address, or
• International Mobile Equipment Identity (IMEI) number

Internet protocol address

Provide the Internet Protocol (IP) address.

It is the unique identifying number assigned to every device connected to the internet.

Date and time of online session in which request was made

This is the date and time the requester accessed the online environment where the disbursement was requested.

† Name of entity

Refer to Name fields under “Standardized field instructions”.

Client number

Provide the client number.

It is the unique identifying number assigned by the casino to the entity requesting the disbursement.

House/Building number

Refer to Address fields under "Standardized field instructions".

Apt/Room/Suite/Unit number

Same instructions (Address fields)

† Street address

Same instructions (Address fields)

† City

Same instructions (Address fields)

District

Same instructions (Address fields)

† Province or state (code)

Same instructions (Address fields)

† Province or state (name)

Same instructions (Address fields)

Sub-province and/or sub-locality

Same instructions (Address fields)

† Country

Same instructions (Address fields)

Postal or zip code

Same instructions (Address fields)

Unstructured address details

Refer to Unstructured address field under "Standardized field instructions".

Telephone number

Refer to Telephone number fields under "Standardized field instructions".

Extension number

Same instructions (Telephone number fields)

† Nature of the entity’s principal business

Refer to Occupation/business fields under "Standardized field instructions".

‡ Do you have incorporation or registration information?

This field is a “Yes/No” question.

Select “Yes” if you have the information.

Select ‘No’ if you do not have the information.

Is the entity incorporated or registered?

Select the incorporation or registration type.

† Incorporation number

Provide the incorporation number of the entity requesting the disbursement for each jurisdiction where the entity is incorporated.

† Jurisdiction of issue (country) of incorporation

Provide the country that issued the documentation used to identify the entity for each jurisdiction where the entity is incorporated.

† Jurisdiction of issue (province or state) (code) of incorporation

Provide the jurisdiction of issue (province or state code) of incorporation for each jurisdiction where the entity is incorporated.

If the jurisdiction is a province or state in Canada, the United States or Mexico, select the code from the list of options.

† Jurisdiction of issue (province or state) (name) of incorporation

If the jurisdiction is outside Canada, the United States or Mexico, provide the name of the province or state.

† Registration number

Provide the registration number of the entity requesting the disbursement for each jurisdiction where the entity is registered.

For Canadian entities, a registration number can include the 9-digit business number assigned to that entity by the Canada Revenue Agency (CRA).

† Jurisdiction of issue (country) of registration

Provide the country that issued the documentation used to identify the entity for each jurisdiction where the entity is registered.

† Jurisdiction of issue (province or state) (code) of registration

Provide the jurisdiction of issue (province or state) for each jurisdiction where the entity is registered.

If the jurisdiction is a province or state in Canada, the United States or Mexico, select the code from the list of options.

† Jurisdiction of issue (province or state) (name) of registration

If the jurisdiction is outside Canada, the United States or Mexico, provide the name of the province or state.

† Identifier type

Refer to Identification fields under "Standardized field instructions".

† If "Other," please specify

Same instructions (Identification fields)

† Number associated with identifier type

Same instructions (Identification fields)

† Jurisdiction of issue (country)

Same instructions (Identification fields)

† Jurisdiction of issue (province or state) (code)

Same instructions (Identification fields)

† Jurisdiction of issue (province or state) (name)

Same instructions (Identification fields)

† Surname

Refer to Name fields under "Standardized field instructions".

† Given name

Same instructions (Name fields)

Other/Initial

Same instructions (Name fields)

Entity’s user name

Provide the user name of the entity requesting the disbursement online.

Type of device used

Select which device was used to request the disbursement online.

† If "Other," please specify

If “Other” is selected, you must provide the type of device used.

Device identifier number

Provide the device identifier number.

It is a number assigned to the device, such as:

• a Media Access Control (MAC) address, or
• International Mobile Equipment Identity (IMEI) number

Internet protocol address

Provide the Internet Protocol (IP) address.

It is the unique identifying number assigned to every device connected to the internet.

Date and time of online session in which request was made

This is the date and time the requester accessed the online environment where the disbursement was requested.

‡ Was this disbursement requested on behalf of another person or entity?

This field is a "Yes/No" question.

Select "Yes" if the disbursement was requested on behalf of another person or entity.

† Surname

Refer to Name fields under "Standardized field instructions".

† Given name

Same instructions (Name fields)

Other/Initial

Same instructions (Name fields)

Alias

Same instructions (Name fields)

Client number

Provide the client number.

It is the unique identifying number assigned by the casino to the the disbursement was requested was requested.

House/Building number

Refer to Address fields under "Standardized field instructions".

Apt/Room/Suite/Unit number

Same instructions (Address fields)

† Street address

Same instructions (Address fields)

† City

Same instructions (Address fields)

District

Same instructions (Address fields)

† Province or state (code)

Same instructions (Address fields)

† Province or state (name)

Same instructions (Address fields)

Sub-province and/or sub-locality

Same instructions (Address fields)

† Country

Same instructions (Address fields)

Postal or zip code

Same instructions (Address fields)

Unstructured address details

Refer to Unstructured address field under "Standardized field instructions".

Telephone number

Refer to Telephone number fields under "Standardized field instructions".

Extension number

Same instructions (Telephone number fields)

Email address

Provide the email address of the person.

Date of birth

Provide the date of birth of the person.

Country of residence

Enter the primary country of residence for the person.

It can be the same or different from the country entered in the address section.

† Occupation

Refer to Occupation/business fields under "Standardized field instructions".

Name of employer

Same instructions (Occupation/business fields)

Identifier type

Refer to Identification fields under "Standardized field instructions".

† If "Other," please specify

Same instructions (Identification fields)

Number associated with identifier type

Same instructions (Identification fields)

Jurisdiction of issue (country)

Same instructions (Identification fields)

Jurisdiction of issue (province or state) (code)

Same instructions (Identification fields)

Jurisdiction of issue (province or state) (name)

Same instructions (Identification fields)

† Relationship

Select the nature of the relationship of the person on whose behalf the disbursement was requested to the person or entity requesting the disbursement.

† If "Other," please specify

If “Other” is selected, you must specify the nature of the relationship.

† Name of entity

Refer to Name fields under "Standardized field instructions".

Client number

Provide the client number.

It is the unique identifying number assigned by the casino to the entity requesting the disbursement.

House/Building number

Refer to Address fields under "Standardized field instructions".

Apt/Room/Suite/Unit number

Same instructions (Address fields)

† Street address

Same instructions (Address fields)

† City

Same instructions (Address fields)

District

Same instructions (Address fields)

† Province or state (code)

Same instructions (Address fields)

† Province or state (name)

Same instructions (Address fields)

Sub-province and/or sub-locality

Same instructions (Address fields)

† Country

Same instructions (Address fields)

Postal or zip code

Same instructions (Address fields)

Unstructured address details

Refer to Unstructured address field under "Standardized field instructions".

Telephone number

Refer to Telephone number fields under "Standardized field instructions".

Extension number

Same instructions (Telephone number fields)

Email address

Provide the email address of the entity.

† Nature of the entity’s principal business

Refer to Occupation/business fields under "Standardized field instructions".

‡ Do you have incorporation or registration information?

This field is a “Yes/No” question.

Select “Yes” if you have the information.

Select ‘No’ if you do not have the information.

Is the entity incorporated or registered?

Select the incorporation or registration type.

† Incorporation number

Provide the incorporation number of the entity for each jurisdiction where the entity is incorporated.

† Jurisdiction of issue (country) of incorporation

Provide the country that issued the documentation used to identify the entity for each jurisdiction where the entity is incorporated.

† Jurisdiction of issue (province or state) (code) of incorporation

Provide the jurisdiction of issue (province or state code) of incorporation for each jurisdiction where the entity is incorporated.

If the jurisdiction is a province or state in Canada, the United States or Mexico, select the code from the list of options.

† Jurisdiction of issue (province or state) (name) of incorporation

If the jurisdiction is outside Canada, the United States or Mexico, provide the name of the province or state.

† Registration number

Provide the registration number of the entity for each jurisdiction where the entity is registered.

For Canadian entities, a registration number can include the 9-digit business number assigned to that entity by the Canada Revenue Agency (CRA).

† Jurisdiction of issue (country) of registration

Provide the country that issued the documentation used to identify the entity for each jurisdiction where the entity is registered.

† Jurisdiction of issue (province or state) (code) of registration

Provide the jurisdiction of issue (province or state code) of registration for each jurisdiction where entity is registered

If the jurisdiction is a province or state in Canada, the United States or Mexico, select the code from the list of options.

† Jurisdiction of issue (province or state) (name) of registration

If the jurisdiction is outside Canada, the United States or Mexico, provide the name of the province or state.

Identifier type

Refer to Identification fields under "Standardized field instructions".

† If "Other," please specify

Same instructions (Identification fields)

Number associated with identifier type

Same instructions (Identification fields)

Jurisdiction of issue (country)

Same instructions (Identification fields)

Jurisdiction of issue (province or state) (code)

Same instructions (Identification fields)

Jurisdiction of issue (province or state) (name)

Same instructions (Identification fields)

Surname

Refer to Name fields under "Standardized field instructions".

Given name

Same instructions (Name fields)

Other/Initial

Same instructions (Name fields)

† Relationship

Select the nature of the relationship of the entity on whose behalf the disbursement was requested to the person or entity requesting the disbursement.

† If "Other," please specify

If “Other” is selected, you must specify the nature of the relationship.

* Type of disbursement

Select how the disbursement was completed.

If the type of disbursement is not in the list provided, you must select “Other” and provide the type of disbursement

† If "Other," please specify

If “Other” is selected, you must provide a brief description of how the disbursement was completed.

† Amount

Enter the total amount of funds involved in the completing action.

If this amount was not in Canadian dollars, do not convert it to CAD, but provide the currency type in the next field.

† Currency

If the completing action was in funds, enter the currency code, including if it was in Canadian dollars.

If the currency type is not in the list provided, you must select “Other” and provide the full name of the currency.

† Value in Canadian dollars

Enter the value in Canadian dollars if the disbursement was not conducted using funds (for example, jewelry).

‡ Account category

Select the account type.

† Casino account type

Select the type of casino account used in the disbursement.

† If "Other," please specify

If “Other” is selected, you must provide the casino account type.

† Account number

Provide the account number for the casino account.

† Account currency

Enter the currency code of the account, including if it was in Canadian dollars.

If the currency type is not in the list provided, you must select “Other” and provide the full name of the currency.

Date account opened

Provide the date the account was opened.

† Casino identifier number where the account is held

Provide the unique number assigned by FINTRAC designated for the casino.

House/Building number

Refer to Address fields under "Standardized field instructions".

Apt/Room/Suite/Unit number

Same instructions (Address fields)

† Street address

Same instructions (Address fields)

† City

Same instructions (Address fields)

District

Same instructions (Address fields)

† Province or state (code)

Same instructions (Address fields)

† Province or state (name)

Same instructions (Address fields)

Sub-province and/or sub-locality

Same instructions (Address fields)

† Country

Same instructions (Address fields)

Postal or zip code

Same instructions (Address fields)

† Surname

Refer to Name fields under "Standardized field instructions".

† Given name

Same instructions (Name fields)

Other/Initial

Same instructions (Name fields)

† Name of entity

Refer to Name fields under "Standardized field instructions".

† Account type

Select the financial institution account type.

† If "Other", please specify

If “Other” is selected, you must provide the financial institution account type.

† Financial institution number

Provide the financial institution number.

† Branch number

Provide the branch number.

† Account number

If the disbursement involves an account at a financial entity provide that account number.

† Account currency

Enter the currency code of the account, including if it was in Canadian dollars.

If the currency type is not in the list provided, you must select “Other” and provide the full name of the currency.

Date account opened

Provide the date the account was opened.

† Surname

Refer to Name fields under "Standardized field instructions".

† Given name

Same instructions (Name fields)

Other/Initial

Same instructions (Name fields)

† Name of entity

Refer to Name fields under "Standardized field instructions".

† Reference number

If the disbursement involved a reference number, provide it in this field.

Other number related to reference number

Provide any other number related to the reference number as applicable.

‡ Was there any other person or entity involved in the completing action?

This field is a “Yes/No” question.

Select “Yes” if there was any other person or entity involved in the completing action.

Refer to Name fields under "Standardized field instructions".

† Given name

Same instructions (Name fields)

Other/Initial

Same instructions (Name fields)

† Account number

Provide the account number of the person involved in the completing action.

It is acceptable to include the financial institution number and branch number as part of an account number.

† Policy number

Provide the policy number.

† Identifying number

If there is no account or policy number, provide an identifying number if available.

Refer to Name fields under "Standardized field instructions".

† Account number

Provide the account number of the entity involved in the completing action.

It is acceptable to include the financial institution number and branch number as part of an account number.

† Policy number

Provide the policy number.

† Identifying number

If there is no account or policy number, provide an identifying number if available.

† Surname

Refer to Name fields under "Standardized field instructions".

† Given name

Same instructions (Name fields)

Other/Initial

Same instructions (Name fields)

Alias

Same instructions (Name fields)

Client number

Provide the client number.

It is the unique identifying number assigned by the casino to the person receiving the disbursement.

House/Building number

Refer to Address fields under "Standardized field instructions".

Apt/Room/Suite/Unit number

Same instructions (Address fields)

† Street address

Same instructions (Address fields)

† City

Same instructions (Address fields)

District

Same instructions (Address fields)

† Province or state (code)

Same instructions (Address fields)

† Province or state (name)

Same instructions (Address fields)

Sub-province and/or sub-locality

Same instructions (Address fields)

† Country

Same instructions (Address fields)

Postal or zip code

Same instructions (Address fields)

Unstructured address details

Refer to Unstructured address field under "Standardized field instructions".

Telephone number

Refer to Telephone number fields under "Standardized field instructions".

Extension number

Same instructions (Telephone number fields)

Email address

Provide the email address of the person.

Online user name

Provide the online user name of the person.

Date of birth

Provide the date of birth of the person.

Country of residence

Enter the primary country of residence for the person.

It can be the same or different from the country entered in the address section.

Occupation

Refer to Occupation/business fields under "Standardized field instructions".

Name of employer

Same instructions (Occupation/business fields)

Identifier type

Refer to Identification fields under "Standardized field instructions".

† If "Other," please specify

Same instructions (Identification fields)

Number associated with identifier type

Same instructions (Identification fields)

Jurisdiction of issue (country)

Same instructions (Identification fields)

Jurisdiction of issue (province or state) (code)

Same instructions (Identification fields)

Jurisdiction of issue (province or state) (name)

Same instructions (Identification fields)

† Relationship

Select the nature of the relationship of the person receiving the disbursement to the person or entity requesting the disbursement.

† If "Other," please specify

If “Other” is selected, you must specify the nature of the relationship.

Relationship

Select the nature of the relationship of the person receiving the disbursement to the person or entity on whose behalf the disbursement was requested.

† If "Other," please specify

If “Other” is selected, you must specify the nature of the relationship.

† Name of entity

Refer to Name fields under "Standardized field instructions".

Client number

Provide the client number of the entity.

It is the unique identifying number assigned by the casino to the entity receiving the disbursement.

House/Building number

Refer to Address fields under "Standardized field instructions".

Apartment/Room/Suite/Unit number

Same instructions (Address fields)

† Street address

Same instructions (Address fields)

† City

Same instructions (Address fields)

District

Same instructions (Address fields)

† Province or state (code)

Same instructions (Address fields)

† Province or state (name)

Same instructions (Address fields)

Sub-province and/or sub-locality

Same instructions (Address fields)

† Country

Same instructions (Address fields)

Postal or zip code

Same instructions (Address fields)

Unstructured address details

Refer to Unstructured address field under "Standardized field instructions".

Telephone number

Refer to Telephone number fields under "Standardized field instructions".

Extension number

Same instructions (Telephone number fields)

Email address

Provide the email address of the entity.

Online user name

Provide the online user name of the entity.

Nature of entity’s principal business

Refer to Occupation/business fields under "Standardized field instructions".

‡ Do you have incorporation or registration information?

This field is a “Yes/No” question.

Select “Yes” if you have the information.

Select ‘No’ if you do not have the information.

Is the entity incorporated or registered?

Select the incorporation or registration type.

Incorporation number

Provide the incorporation number of the entity receiving the disbursement for each jurisdiction where the entity is incorporated.

Jurisdiction of issue (country) of incorporation

Provide the country that issued the documentation used to identify the entity receiving the disbursement for each jurisdiction where the entity is incorporated.

Jurisdiction of issue (province or state) (code) of incorporation

Provide the jurisdiction of issue (province or state code) of incorporation for each jurisdiction where the entity is incorporated.

If the jurisdiction is a province or state in Canada, the United States or Mexico, select the code from the list of options.

Jurisdiction of issue (province or state) (name) of incorporation

If the jurisdiction is outside Canada, the United States or Mexico, provide the name of the province or state.

Registration number

Provide the registration number of the entity receiving the disbursement for each jurisdiction where the entity is registered.

For Canadian entities, a registration number can include the 9-digit business number assigned to that entity by the Canada Revenue Agency (CRA).

Jurisdiction of issue (country) of registration

Provide the country that issued the documentation used to identify the entity receiving the disbursement for each jurisdiction where the entity is registered.

Jurisdiction of issue (province or state) (code) of registration

Provide the jurisdiction of issue (province or state) for each jurisdiction where the entity is registered.

If the jurisdiction is a province or state in Canada, the United States or Mexico, select the code from the list of options.

Jurisdiction of issue (province or state) (name) of registration

If the jurisdiction is outside Canada, the United States or Mexico, provide the name of the province or state.

Identifier type

Refer to Identification fields under "Standardized field instructions".

† If "Other," please specify

Same instructions (Identification fields)

Number associated with identifier type

Same instructions (Identification fields)

Jurisdiction of issue (country)

Same instructions (Identification fields)

Jurisdiction of issue (province or state) (code)

Same instructions (Identification fields)

Jurisdiction of issue (province or state) (name)

Same instructions (Identification fields)

Surname

Refer to Name fields under "Standardized field instructions".

Given name

Same instructions (Name fields)

Other/Initial

Same instructions (Name fields)

† Relationship

Select the nature of the relationship of the entity receiving the disbursement to the person or entity requesting the disbursement.

† If "Other," please specify

If “Other” is selected, you must specify the nature of the relationship.

Relationship

Select the nature of the relationship of the entity receiving the disbursement to the person or entity on whose behalf the disbursement was requested.

† If "Other," please specify

If “Other” is selected, you must specify the nature of the relationship.

‡ Was this disbursement received on behalf of another person or entity?

This field is a "Yes/No" question.

Select "Yes" if the disbursement was received on behalf of another person or entity.

† Surname

Refer to Name fields under "Standardized field instructions".

† Given name

Same instructions (Name fields)

Other/Initial

Same instructions (Name fields)

Alias

Same instructions (Name fields)

Client number

Provide the client number.

It is the unique identifying number assigned by the casino to the person on whose behalf the disbursement was received.

House/Building number

Refer to Address fields under "Standardized field instructions".

Apt/Room/Suite/Unit number

Same instructions (Address fields)

† Street address

Same instructions (Address fields)

† City

Same instructions (Address fields)

District

Same instructions (Address fields)

† Province or state (code)

Same instructions (Address fields)

† Province or state (name)

Same instructions (Address fields)

Sub-province and/or sub-locality

Same instructions (Address fields)

† Country

Same instructions (Address fields)

Postal or zip code

Same instructions (Address fields)

Unstructured address details

Refer to Unstructured address field under "Standardized field instructions".

Telephone number

Refer to Telephone number fields under "Standardized field instructions".

Extension number

Same instructions (Telephone number fields)

Email address

Provide the email address of the person.

Online user name

Provide the online user name of the person.

Date of birth

Provide the date of birth of the person.

Country of residence

Enter the primary country of residence for the person.

It can be the same or different from the country entered in the address section.

Occupation

Refer to Occupation/business fields under "Standardized field instructions".

Name of employer

Same instructions (Occupation/business fields)

Identifier type

Refer to Identification fields under "Standardized field instructions".

† If "Other," please specify

Same instructions (Identification fields)

Number associated with identifier type

Same instructions (Identification fields)

Jurisdiction of issue (country)

Same instructions (Identification fields)

Jurisdiction of issue (province or state) (code)

Same instructions (Identification fields)

Jurisdiction of issue (province or state) (name)

Same instructions (Identification fields)

† Relationship

Select the nature of the relationship of the person on whose behalf the disbursement was received to the person or entity receiving the disbursement.

† If "Other," please specify

If “Other” is selected, you must specify the nature of the relationship.

Relationship

Select the nature of the relationship of the person of the person on whose behalf the disbursement was received to the person or entity requesting the disbursement.

† If "Other," please specify

If “Other” is selected, you must specify the nature of the relationship.

† Name of entity

Refer to Name fields under "Standardized field instructions".

Client number

Provide the client number of the entity.

House/Building number

Refer to Address fields under "Standardized field instructions".

Apartment/Room/Suite/Unit number

Same instructions (Address fields)

† Street address

Same instructions (Address fields)

† City

Same instructions (Address fields)

District

Same instructions (Address fields)

† Province or state (code)

Same instructions (Address fields)

† Province or state (name)

Same instructions (Address fields)

Sub-province and/or sub-locality

Same instructions (Address fields)

† Country

Same instructions (Address fields)

Postal or zip code

Same instructions (Address fields)

Unstructured address details

Refer to Unstructured address field under "Standardized field instructions".

Telephone number

Refer to Telephone number fields under "Standardized field instructions".

Extension number

Same instructions (Telephone number fields)

Email address

Provide the email address of the entity

Online user name

Provide the online user name of the entity

Nature of entity’s principal business

Refer to Occupation/business fields under "Standardized field instructions".

‡ Do you have incorporation or registration information?

This field is a “Yes/No” question.

Select “Yes” if you have the information.

Select ‘No’ if you do not have the information.

Is the entity incorporated or registered?

Select the incorporation or registration type.

Incorporation number

Provide the incorporation number of the entity on whose behalf the disbursement was received for each jurisdiction where the entity is incorporated.

Jurisdiction of issue (country) of incorporation

Provide the country that issued the documentation used to identify the entity on whose behalf the disbursement was received for each jurisdiction where the entity is incorporated.

Jurisdiction of issue (province or state) (code) of incorporation

Provide the jurisdiction of issue (province or state code) of incorporation for each jurisdiction where the entity is incorporated.

If the jurisdiction is a province or state in Canada, the United States or Mexico, select the code from the list of options.

Jurisdiction of issue (province or state) (name) of incorporation

If the jurisdiction is outside Canada, the United States or Mexico, provide the name of the province or state.

Registration number

Provide the registration number of the entity on whose behalf the disbursement was received for each jurisdiction where the entity is registered.

For Canadian entities, a registration number can include the 9-digit business number assigned to that entity by the Canada Revenue Agency (CRA).

Jurisdiction of issue (country) of registration

Provide the country that issued the documentation used to identify the entity on whose behalf the disbursement was received for each jurisdiction where the entity is registered.

Jurisdiction of issue (province or state) (code) of registration

Provide the jurisdiction of issue (province or state) for each jurisdiction where the entity is registered.

If the jurisdiction is a province or state in Canada, the United States or Mexico, select the code from the list of options.

Jurisdiction of issue (province or state) (name) of registration

If the jurisdiction is outside Canada, the United States or Mexico, provide the name of the province or state.

Identifier type

Refer to Identification fields under "Standardized field instructions".

† If "Other," please specify

Same instructions (Identification fields)

Number associated with identifier type

Same instructions (Identification fields)

Jurisdiction of issue (country)

Same instructions (Identification fields)

Jurisdiction of issue (province or state) (code)

Same instructions (Identification fields)

Jurisdiction of issue (province or state) (name)

Same instructions (Identification fields)

Surname

Refer to Name fields under "Standardized field instructions".

Given name

Same instructions (Name fields)

Other/Initial

Same instructions (Name fields)

† Relationship

Select the nature of the relationship of the entity on whose behalf the disbursement was received to the person or entity receiving the disbursement.

† If "Other," please specify

If “Other” is selected, you must specify the nature of the relationship.

Relationship

Select the nature of the relationship of the entity on whose behalf the disbursement was received to the person or entity requesting the disbursement.

† If "Other," please specify

If “Other” is selected, you must specify the nature of the relationship.

Fields

Information provided by Big Money Casino

* Reporting entity number

1234567

‡ Reporting entity report reference number

CDR15137-2168517

Whom can FINTRAC contact about this report?

Information about the person at Big Money Casino that FINTRAC can liaise with in the event that a follow up is required

‡ 24-hour aggregation type

Not applicable

‡ 24-hour period start date and time

 2024-10-29T00:00:00±ZZ:ZZ

‡ 24-hour period end date and time

 2024-10-29T23:59:59±ZZ:ZZ

* Date of disbursement

2024-10-29

* Time of disbursement

22:10:55±ZZ:ZZ

*Method of disbursement

In person

‡ Threshold indicator

Above threshold

‡ Reporting entity transaction reference number

CDR20241031-093

*Reporting entity location number

567

† Street address

22 Bank Street

† City

Ottawa

† Country

Canada

† Province or state code

ON

Postal or zip code

K2S 9P9

*Reason of disbursement

Front cash withdrawal

† Amount

11,000

† Currency

CAD

Account category

Casino account

†Casino account type

Front money

† Account number

98765

† Account currency

CAD

Date account opened

2022-06-11

†Casino identifier number where the account is held

456123

House/Building number

35

Apt/Room/Suite/Unit number

1200

† Street address

Summer Street

† City

Toronto

† Province or state code

ON

Front

Canada

Postal or zip code

L2A 7T7

†Surname

Brown

† Given name

Benny

† Surname

Brown

† Given name

Benny

Client number

987654

House/Building number

22

† Street address

Nation Street

† City

Ottawa

† Province or state (code)

ON

† Country

Canada

Postal or zip code

K2S 1Q1

Telephone number

613-987-6543

Email address

lastx@domain.com

† Date of birth

2000-01-01

Country of residence

Canada

† Occupation

Project manager

Name of employer

Company A

† Identifier type

Passport

† Number associated with identifier type

AA12345678

† Jurisdiction of issue (country)

Canada

† Jurisdiction of issue (province or state) (code)

ON

‡Was this disbursement requested on behalf of another person or entity?

No

* Type of disbursement

Paid out in cash

† Amount

11,000

† Currency

CAD

‡ Account category

Not applicable

‡Was there any other person or entity involved in the disbursement?

No

† Surname

Brown

† Given name

Benny

Client number

987654

House/Building number

22

† Street address

Nation Street

† City

Ottawa

† Province or state (code)

ON

† Country

Canada

Postal or zip code

K2S 1Q1

Telephone number

613-987-6543

Online user name

lastx@domain.com

† Date of birth

2000-01-01

Country of residence

Canada

Occupation

Project manager

Name of employer

Company A

Identifier type

Passport

Number associated with identifier type

AA12345678

Jurisdiction of issue (country)

Canada

Jurisdiction of issue (province or state) (code)

ON

† Relationship

Self

‡Was this disbursement received on behalf of another person or entity?

No

* Reporting entity number

1234567

‡Reporting entity report reference number

CDR15137-2168517

Whom can FINTRAC contact about this report?

Information about the person at Big Money Casino that FINTRAC can liaise with in the event that a follow up is required

‡ 24-hour aggregation type

Not applicable

‡ 24-hour period start date and time

 2024-10-29T00:00:00±ZZ:ZZ

‡ 24-hour period end date and time

 2024-10-29T23:59:59±ZZ:ZZ

*Date of disbursement

2024-10-29

*Time of disbursement

12:10:55±ZZ:ZZ

*Method of disbursement

In person

‡ Threshold indicator

Above threshold

‡ Reporting entity transaction reference number

CDR20241031-093

*Reporting entity location number

567

† Street address

 22 Bank Street

† City

 Ottawa

† Province or state (code)

 ON

† Country

 Canada

Postal or zip code

K2S 9P9

*Reason of disbursement

Redemption – chips or tokens

† Amount

25,000

† Currency

CAD

‡ Account category

Not applicable

† Surname

Red

† Given name

Poppy

House/Building number

22

Apartment number

800

† Street address

Nation Street

† City

Ottawa

† Province or state (code)

ON

† Country

Canada

Postal or zip code

K2S 1Q1

Telephone number

613-987-6543

Email address

lastx@pwc.com

† Date of birth

2000-01-01

Country of residence

Canada

† Occupation

Accountant

Name of employer

Accounting A

† Identifier type

Passport

† Number associated with identifier type

AA121381327

† Jurisdiction of issue (country)

Canada

† Jurisdiction of issue (province or state) (code)

ON

‡ Was this disbursement requested on behalf of another person or entity?

Yes

† Surname

Red

† Given name

Robert

Client number

34643

House/Building number

77

† Street address

Morning Street

† City

Toronto

† Country

Canada

† Province or state (code)

ON

Postal or zip code

L9S 1W1

Telephone number

647-900-8877

Email address

Robby.reddy@domain.com

Date of birth

1982-09-11

Country of residence

Canada

† Occupation

Manager

Name of employer

Accounting B

Identifier type

Driver’s licence

Number associated with identifier type

34456-45676-245

Jurisdiction of issue (country)

Canada

Jurisdiction of issue (province or state) (code)

ON

† Relationship

Relative

* Type of disbursement

Issued a cheque

† Amount

25,000

† Currency

CAD

‡ Account category

Not applicable

‡ Was there any other person or entity involved in the disbursement?

No

† Surname

Red

† Given name

Poppy

Client number

987654

House/Building number

22

Apt/Room/Suite/Unit number

800

† Street address

Nation Street

† City

Ottawa

† Province or state (code)

ON

† Country

Canada

Postal or zip code

K2S 1Q1

Telephone number

613-987-6543

Email address

lastx@pwc.com

† Date of birth

2000-01-01

Country of residence

Canada

Occupation

Accountant

Name of employer

Accounting A

Identifier type

Passport

Number associated with identifier type

AA121381327

Jurisdiction of issue (country)

Canada

Jurisdiction of issue (province or state) (code)

ON

† Relationship

Self                                                  

Relationship

Relative

‡ Was this disbursement received on behalf of another person or entity?

Yes

† Surname

Red

† Given name

Robert

Client number

34643

House/Building number

77

† Street address

Morning Street

† City

Toronto

† Province or state (code)

ON

† Country

Canada

Postal or zip code

L9S 1W1

Telephone number

647-900-8877

Email address

Robby.reddy@domain.com

Date of birth

1982-09-11

Country of residence

Canada

Occupation

Manager

Name of employer

Accounting B

Identifier type

Driver’s licence

Number associated with identifier type

34456-45676-245

Jurisdiction of issue (country)

Canada

Jurisdiction of issue (province or state) (code)

ON

† Relationship

Relative

Relationship

Relative

* Reporting entity number

1234567

‡ Reporting entity report reference number

CDR15137-2168517

Whom can FINTRAC contact about this report

Information about the person at Big Money Casino that FINTRAC can liaise with in the event that a follow up is required

‡ 24-hour aggregation type

Requester

‡ 24-hour period start date and time

 2024-10-29T22:00:00±ZZ:ZZ

‡ 24-hour period end date and time

 2024-10-30T21:59:59±ZZ:ZZ

*Date of disbursement

2024-10-29

2024-10-30

*Time of disbursement

22:59:50±ZZ:ZZ

21:00:00±ZZ:ZZ

*Method of disbursement

In person

Online

‡ Threshold indicator

Above threshold

Below Threshold

‡ Reporting entity transaction reference number

CDR20241031-093

CDR20241031-099

*Reporting entity location number

567

567

† Street address

 22 Bank Street

 22 Bank Street

† City

 Ottawa

 Ottawa

† Country

 Canada

 Canada

† Province or state (code)

 ON

 ON

Postal or zip code

K2S 9P9

K2S 9P9

*Reason of disbursement

Front cash withdrawal

Front cash withdrawal

† Amount

20,000

4,000

† Currency

CAD

CAD

‡ Account category

Casino account

Casino account

†Casino account type

Front money

Front money

† Account number

98765

78765

† Account currency

CAD

CAD

Date account opened

 2022-06-11

2023-07-11

†Casino identifier number where the account is held

456123

456123

House/Building number

35

35

Apt/Room/Suite/Unit number

1200

1200

† Street address

Summer Street

Summer Street

† City

Toronto

Toronto

† Province or state (code)

ON

ON

† Country

Canada

Canada

Postal or zip code

L2A 7T7

L2A 7T7

†Surname

Green

Green

† Given name

Madeline

Madeline

† Surname

Green

Green

† Given name

Madeline

Madeline

House/Building number

22

22

Apt/Room/Suite/Unit number

800

800

† Street address

Nation Street

Nation Street

† City

Ottawa

Ottawa

† Province or state (code)

ON

ON

† Country

Canada

Canada

Postal or zip code

K2S 1Q1

K2S 1Q1

Telephone number

613-987-6543

613-987-6543

Email address

Green@domain.com

Green@domain.com

† Date of birth

2000-01-01

2000-01-01

Country of residence

Canada

Canada

† Occupation

Accountant

Accountant

Name of employer

Company A

Company A

† Identifier type

Passport

Passport

† Number associated with identifier type

AA121381327

AA121381327

† Jurisdiction of issue (country)

Canada

Canada

† Jurisdiction of issue (province or state) (code)

ON

ON

Type of device used

Mobile phone

Username

Mad.D.Green

Device identifier number

ABC59599

Internet protocol address

222.888.333

Date and time of online session in which request was made

2023-10-30
21:00:00±ZZ:ZZ

‡Was this disbursement requested on behalf of another person or entity?

No

No

* Type of disbursement

Transferred to another casino

Deposited to an account at a financial institution

†Amount

20,000

4,000

†Currency

CAD

CAD

‡ Account category

Casino account

Financial institution account

†Casino account type

Front money

† Account number

78765

† Account currency

CAD

Date account opened

2023-07-11

†Casino identifier number where the account is held

956127

House/building number

15

Apt/Room/Suite/Unit number

1000

† Street address

Front Street

† City

Toronto

†Province or state code

ON

† Country

Canada

Postal or zip code

L2A 7T8

†Surname

Green

† Given name

Madeline

† Account type

Personal

† Financial institution number

10

† Branch number

231667

† Account number

9876543

† Account currency

CAD

Date account opened

2000-21-03

†Surname

Green

† Given name

Madeline

‡ Was there any other person or entity involved in the disbursement?

No

No

† Surname

Green

Green

† Given name

Madeline

Madeline

House/Building number

22

22

Apt/Room/Suite/Unit number

800

800

† Street address

Nation Street

Nation Street

† City

Ottawa

Ottawa

† Province or state (code)

ON

ON

† Country

Canada

Canada

Postal or zip code

K2S 1Q1

K2S 1Q1

Telephone number

613-987-6543

613-987-6543

Email address

Green@domain.com

Green@domain.com

† Date of birth

2000-01-01

2000-01-01

Country of residence

Canada

Canada

Occupation

Accountant

Accountant

Name of employer

Company A

Company A

Identifier type

Passport

Passport

Number associated with identifier type

AA121381327

AA121381327

Jurisdiction of issue (country)

Canada

Canada

Jurisdiction of issue (province or state) (code)

ON

ON

† Relationship

Self                                                  

Self                                                  

‡ Was this disbursement received on behalf of another person or entity?

No

No

* Reporting entity number

1234567

‡ Reporting entity report reference number

CDR15137-2168517

Whom can FINTRAC contact about this report?

Information about the person at Big Money Casino that FINTRAC can liaise with in the event that a follow up is required

‡ 24 hour aggregation type

Requester

‡ 24-hour period start date and time

 2024-10-29T22:00:00±ZZ:ZZ

‡ 24-hour period end date and time

 2024-10-29T21:59:59±ZZ:ZZ

*Date of disbursement

2024-10-29

2024-10-30

*Time of disbursement

22:59:50±ZZ:ZZ

21:00:00±ZZ:ZZ

*Method of disbursement

In person

In person

‡ Threshold indicator

Below threshold

Below threshold

‡ Reporting entity transaction reference number

CDR20241031-093

CDR20241031-099

*Reporting entity location number

567

561

† Street address

 22 Bank Street

21 First Street

† City

 Ottawa

Ottawa

† Country

 Canada

Canada

† Province or state (code)

 ON

ON

Postal of zip code

K2S 9P9

K2S 9P8

*Reason of disbursement

Redemption – chips

Redemption - slot tickets

† Amount

8,000

3,000

† Currency

CAD

CAD

‡ Account information type

Not applicable

Not applicable

† Surname

Blue

Blue

† Given name

Sam

Sam

Apt/Room/Suite/Unit number

600

600

House/Building number

22

22

† Street address

Nation Street

Nation Street

† City

Ottawa

Ottawa

† Country

Canada

Canada

† Province or state (code)

ON

ON

Postal or zip code

K2S 1Q1

K2S 1Q1

Telephone number

613-987-6543

613-987-6543

Email address

Blue@domain.com

Blue@domain.com

† Date of birth

1980-01-01

1980-01-01

Country of residence

Canada

Canada

† Occupation

Accountant

Accountant

Name of employer

Company A

Company A

† Identifier type

Passport

Passport

† Number associated with identifier type

AA121381327

AA121381327

† Jurisdiction of issue (country)

Canada

Canada

† Jurisdiction of issue (province or state) (code)

ON

ON

‡Was this disbursement requested on behalf of another person or entity?

No

Yes

† Name of entity

Kitchen Supply Company Inc.

House/Building number

11

† Street address

Yonge Street

† City

Toronto

† Country

Canada

† Province or state (code)

ON

Postal or zip code

L9S 1W1

Telephone number

647-900-8877

Email address

KitchenSupply@domain.com

† Nature of entity’s principal business

Kitchen supplies

‡ Do you have incorporation or registration information?

Yes

† Is the entity incorporated or registered?

Incorporated

† Incorporation number

875234

† Jurisdiction of issue (country) of incorporation

Canada

† Jurisdiction of issue (province or state) (code) of incorporation

ON

Identifier type

Certificate of incorporation

Number associated with identifier type

A4567223

Jurisdiction of issue (country)

Canada

Jurisdiction of issue (province or state) (code)

ON

Surname

Blue

Given name

Sam

†Relationship

Legal counsel

* Type of disbursement

Paid out in cash

Sent domestic funds transfer

† Amount

8,000

3,000

† Currency

CAD

CAD

‡ Account category

Not applicable

Financial institution account

† Account type

Business

† Financial institution number

10

† Branch number

231667

† Account number

9876543

† Account currency

CAD

Date account opened

2000-03-21

†Name of entity

Kitchen Supply Company

‡Was there any other person or entity involved in the disbursement?

Yes

No

†Surname

Yellow

† Given name

Yara

† Account number

435678

† Surname

Blue

† Given name

Sam

Apt/Room/Suite/Unit number

600

House/Building number

22

† Street address

Nation Street

† City

Ottawa

† Country

Canada

† Province or state (code)

ON

Postal or zip code

K2S 1Q1

Telephone number

613-987-6543

Email address

Blue@domain.com

† Date of birth

1980-01-01

Country of residence

Canada

Occupation

Accountant

Name of employer

Company A

Identifier type

Passport

Number associated with identifier type

AA121381327

Jurisdiction of issue (country)

Canada

Jurisdiction of issue (province or state) (code)

ON

†Relationship

Self

† Name of entity

Kitchen Supply Company Inc.

House/Building number

11

† Street address

Yonge Street

† City

Toronto

† Country

Canada

† Province or state (code)

ON

Postal or zip code

L9S 1W1

Telephone number

647-900-8877

Email address

KitchenSupply@domain.com

† Nature of entity’s principal business

Kitchen Supplies

‡ Do you have incorporation or registration information?

Yes

Is the entity incorporated or registered?

Incorporated

Incorporation number

875234

Jurisdiction of issue (country) of incorporation

Canada

Jurisdiction of issue (province or state) (code) of incorporation

ON

Identifier type

Certificate of incorporation

Number associated with identifier type

A4567223

Jurisdiction of issue (country)

Canada

Jurisdiction of issue (province or state) (code)

ON

Surname

Blue

Given name

Sam

†Relationship

Employer

Relationship

Self

‡ Was this disbursement received on behalf of another person or entity?

No

No