A23.

Off-site Data Collection Form

BANK NAME:
REPORTING DATE:
REPORTING PERIOD:
Data filling instructions:
1 Please write Not Applicable (N/A) whether Development Bank and Finance company are not relevant with information.
2 Please write amount/value in Million

A: CUSTOMER BASE
Deposit Mix No. of Customers Deposit Amount
Current deposits
Savings deposits
Time/Fixed deposits
Call Deposit
Others
Total Number of Customers - -
B: CUSTOMER BASE ACCORDING TO PLACE OF RESIDENCE
Customers No. of Customers Deposits
Resident
Non-resident
Total - -
C: BREAKDOWN OF BALANCE OF DEPOSIT PRODUCTS BY TYPE AND CUSTOMER
Type of Deposit Natural Person Legal Person
Resident Non-resident Resident Non-resident
Current deposits
Savings deposits
Time/Fixed deposits
Call deposits
Other
Total - - - -
D: BREAKDOWN OF BALANCE OF CREDIT PRODUCTS BY TYPE AND CUSTOMER
Type of Credit Natural Person Legal Person
Resident Non-resident Resident Non-resident
(i) Cash, Gold and Govt. Securities
Secured Loans
(ii) Margin type/nature loan
(iii) Other Loans (except i & ii)
(iv) Prepayment of Term Loans (in
Cash)
Total - - - -
E: BREAKDOWN OF OTHER BANKING PRODUCTS AND SERVICES
Products & services Natural Person Legal Person
Resident Non-resident Resident Non-resident
(i) Trade Finance*
(ii) Draft/Pre-paid cards
(iii) Purchase/Sale of Forex
(iv) Remittances
(v) Wire Transfers (SWIFT, TT etc.)

(vi) Correspondent Banking

*In the extent of applicable to "B" and "C" Class instituition
F: CUSTOMER RISK PROFILE AS DETERMINED BY THE BANK BASED ON INTERNAL RISK ASSESSMENT
Risk Grade No. of Customers Amount of Deposit
Low Risk Customers
Medium Risk customers
High Risk customers
Total - -

G: POLITICALLY EXPOSED PERSONS (PEPs) & RELATED COMPANIES/AFFILIATIONS

Loans and on-balance sheet exposures Deposits
Particulars
No. of Customers Amount No. of Customers Amount
Domestic
Foreign
International
Total - - - -
H: BREAKDOWN OF RELATIONSHIPS WITH PEPs
Type of Deposit Domestic PEP Foreign PEP International PEP
Current accounts
Savings accounts
Time/Fixed deposits accounts
Call accounts
Others
Total Amount - - -
 A23. Off-site Data Collection Form

I: PRIVATE/VIP BANKING CUSTOMERS

Loans and on-balance
VIP Banking Customers Number of customers sheet exposures Deposits (Amount)
(Amount)
Domestic
Foreign
Total - - -
J: INFORMATION ON CURRENCY RISK
Particulars Local Currency Transaction in Cash* Foreign Currency Transaction in
1. Deposits - Cash* -
(i) Current Deposits
(ii) Savings Deposits
(iii) Time/Fixed Deposits
(iv) Call Deposits
(v) Others
2. Credits 0 0
(i) Cash Secured Loans
(ii) Prepayment of Term Loans (in
Cash)
3. Products & Services 0 0
(I) Wire Transfers (SWIFT, TT etc.)

(ii) Remittances
(iii) Purchase/Sale of Forex
(iv) Draft/Pre-paid cards
* Transaction should be reported in period basis and should be calculated as average of total debit and credit transaction.
K: CROSS BORDER CORRESPONDENT BANKING RELATIONSHIPS (NOT APPLICABLE TO "C")
Number of respondent banks having Total Balance of all accounts Number of Volume of
accounts with the bank at reporting date transactions* transactions*

* The number and volume (debit plus credit amount divided by two) of transaction should be provided in period basis

L: BREAKDOWN OF CUSTOMER TYPE

Types of Customers Number of Customers Total deposits
1. Natural Persons - -
Resident
Non-resident
FATF Public Statement "high-
risk jurisdiction"belonging non-
resident
Other "high-risk
jurisdiction"belonging non-
resident
2. Legal persons - -
Resident
Non-resident
FATF Public Statement "high-
risk jurisdiction"belonging non-
resident
Other "high-risk
jurisdiction"belonging non-
resident
3. Money Remittance Companies
(including agents)
4. Money Exchangers
5. NGOs
6. INGOs
7. Real estate companies (including
agents)
8. Dealers in precious metals and
stones and jewellery shops
9. Securities firms
10. Trust or Legal arrangements (if
any)
11. Charities
12.Cooperatives
Note: No. 3 to 12 are supplementary data of Legal person so these should not exceed the
total of leagal person.
 A23. Off-site Data Collection Form

M: INFORMATION ON GEOGRAPHIC RISK (Amount)

Inside Nepal Outside Nepal
Foreign
countries Foreign
Deposit and Credit Product All foreign designated countries
Kathmandu Valley Other Urban Areas* Rural Areas
countries by the designated
FATF and by the bank
or FIU as high risk
1. Deposits - - - - - -
(i) Current Accounts
(ii) Savings Accounts
(iii) Time/Fixed Deposits
(iv) Call Accounts
(v) Others
2. Credits - - - - - -
(i) Cash Secured Loans
(ii) Prepaid Term Loans (in Cash)
3. Products & Services - - - - - -
(i) Wire Transfers (SWIFT, TT etc.)

(ii) Remittances
(iii) Purchase/Sale of Forex
(iv) Draft & Pre-paid cards
* Branch at Municipal and
Metropolitan Areas except KTM
Valley.
N: OTHER PRODUCTS AND SERVICES
Products and Services No. of Customers Number of
transactions
1. E-banking/Internet banking
2. Sale of monetary/negotiable
instruments (including travellers
checks)
3. Purchase of monetary
instruments (including travellers
checks)
4. Sale of foreign exchange
5. Purchase of foreign exchange
6. Time/Fixed Deposit Certificates
issued
7. Buying/selling Gold Bullion (If
applicable)

O: WIRE TRANSFERS
Type Number of Incoming Total Value Number of Total Value
Transfers over the period Outgoing Transfers
over the period
1. Wire transfers (SWIFT,TT etc.)*
2. Domestic payments
* except domestic payments
P: OCCASSIONAL/ONE-OFF TRANSACTIONS WITH WALK IN CUSTOMERS (THOSE NOT CUSTOMERS OF THE BANK)
Type Number Total Value
1. Sale of foreign currency and
monetary instruments
2. Purchase of foreign currency and
monetary instruments

Q: SUSPICIOUS TRANSACTION REPORTS

1. Number of Suspicious
Transaction Reports Submitted to
FIU
2. Number of Unusual Transactions
Identified but not yet assessed by
Compliance Officer

3. Number of Unusual Transactions

not reported to FIU after
assessment by Compliance Officer
 A23. Off-site Data Collection Form (instruction)

NEPAL RASTRA BANK

……………. SUPERVISION DEPARTMENT

DATA COLLECTION SHEET FOR RISK BASED APPROACH SUPERVISION ON AML/CFT

As of Please Select Date

&
for the period of Please Select Period (as if necessary)

Instructions for Completing the Data Collection Form

1.
The purpose of this report is to assist the Nepal Rastra Bank (NRB) and Financial Intelligence Unit (FIU) to understand the risks faced by banks in
relation to the money laundering and the financing of terrorism through there products, services and customer base.

2. Banks should complete this report using definitions used by Nepal Rastra Bank in other statistical and prudential reports.

3. All amounts should be reported in Rs. in millions.

4.
Intermediaries/Third parties refers to any financial institution, designated non-financial businesses and professions (DNFBP) or other reliable
persons or businesses that conduct business activities or operations for or on behalf of a customer. This excludes agents.

5. Legal arrangement refers to express trusts or other similar legal arrangements. Examples of other similar arrangements (for AML/CFT purposes)
include fiducie, treuhand, and fideicomiso.
6. Legal person refers to any entities other than natural persons that can establish a permanent customer relationship with a financial institution or
otherwise own property. This can include companies, bodies corporate, foundations, anstalts, partnerships, or associations and other relevantly
similar entities.

SPECIFIC INSTRUCTIONS (please refer the data_col_form A,B,…etc. in worksheet aside)

A: CUSTOMER BASE
Banks should provide information on the number of deposit accounts and total balances as at the reporting date.

B&C: CUSTOMER BASE ACCORDING TO PLACE OF RESIDENCE

Banks should report information on their deposit base according to the place of residence of the depositors at the time the account was opened
and its regular update. Definition of resident and non-resident could be based on your reporting in NRB form no. 9.1 and 9.8 Total reported
numbers of customers should equal those reported in item A.

D: BREAKDOWN OF BALANCE OF CREDIT PRODUCTS BY TYPE AND CUSTOMER

Banks should report information on their credit (loan and advances) in three categories. The first one is cash, gold or government securities
secured loan, the second is all loan and advances except first one. Prepaid term loan (in cash) is the prepayment of any installment of term loan
and it should be calculated during the reporting period. For example, if you are reporting the loan and advance in mid july xxxx, then the
outstanding balance of that day end is required to put in the table with categorization of Natural and legal person and resident and non-
resident. But, in the case of prepaid term loan (in cash), bank should report the total prepaid amount during the reporting period. Such as:
If reporting period is strating of fiscal year to end of fiscal year then whole year's total prepayment.
If reporting period is starting of fiscal year to end of half year then half year's total prepayment.
If reporting period is starting of fiscal year to end of any quarter then quarter's total prepayment.

E: BREAKDOWN OF OTHER BANKING PRODUCTS AND SERVICES

Banks should report outstanding amount of trade finanance and rest of transaction amount during the period.

F: CUSTOMER RISK PROFILE AS DETERMINED BY THE BANK BASED ON INTERNAL RISK ASSESSMENT
Banks should provide information on the risk profile of their deposit customers based on the bank's internal risk
assessment. The number of customers according to risk category should equal to the number of customers reported in
item A.

G: POLITICALLY EXPOSED PERSONS (PEPs) & RELATED COMPANIES/AFFILIATIONS

Banks should report information on their relationships with politically exposed persons. Politically exposed persons are defined as (Please refer
to directive no. 19 for detail):
Foreign Politically exposed person: any person who occupies or previously occupied a prominent public function in a foreign country,
including a position as head of state or government, senior politician, senior judicial or military official, or senior executive of a state owned
corporation. The term includes family members or close associates of such persons.

Domestic politically exposed person: any person who occupies or previously occupied a prominent public function in Nepal, including a
position as head of state or government, senior politician, senior judicial or military official, or senior executive of a state owned corporation.
The term includes family members or close associates of such persons.

International politically exposed person: any person who occupies or occupied high-level management position in an international
organization, including directors, deputy directors, and members of the board. The term includes family members or close associates of such
persons.
Assets/funds under management is a financial term denoting the market value of all the funds being managed by a financial institution (a
mutual fund, hedge fund, or brokerage house) on behalf of its clients, investors, depositors, etc.

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 A23. Off-site Data Collection Form (instruction)

H: BREAKDOWN OF RELATIONSHIPS WITH PEPs

Banks should provide information on the type of deposits from different classes of PEP.

I: PRIVATE/VIP BANKING CUSTOMERS

Banks should provide information on private banking or VIP customers. “Private banking” refers to personalized banking and financial
services provided by banks to private high net worth individuals investing sizable assets. The term "private" refers to the customer service
being rendered on a more personal basis usually via dedicated bank advisers/account officers. Information reported on the number of
relationships should include those customers that are also PEPs.

J: INFORMATION ON CURRENCY RISK

Banks should provide information on the currency in which transactions are conducted. In addition to cash transaction in local currency and
foreign currency banks are also required to include information on non-cash transactions (such as checks, drafts and other payment
instruments) which have the characteristics of cash.

K: CROSS BORDER CORRESPONDENT BANKING RELATIONSHIPS

Banks should provide details of their cross border correspondent banking relationships. Correspondent banking is defined as the provision of
banking services by one bank (the correspondent bank) to another bank (the respondent bank). The respondent bank may be provided with a
range of services by your bank including cash management, international wire transfers and check clearing.

L: BREAKDOWN OF CUSTOMER TYPE

Banks should provide information on their deposit base by customer type.

M: INFORMATION ON GEOGRAPHIC RISK

This section asks banks to provide information the geographic locations/source of business/customers. In particular, banks should identify the
place of residency of the customer or place in which the transaction originated. In relation to domestic transactions banks are asked to classify
transactions as being booked in either Kathmandu valley, other urban area except ktm valley or in rural areas. In relation to transactions
involving jurisidictions outside of Nepal, banks are asked to provide information on all transactions involving persons (natural or legal)
abroad. Banks are also asked to provide information on transactions with persons in countries designated by the Financial Actions Task Force
(or the FIU) as being high risk and also those jurisdictions which the bank has identified as high risk.

N: OTHER PRODUCTS AND SERVICES

Banks should provide information on certain types of products offered and the number of transactions during the period.

O: WIRE TRANSFERS
Banks should provide information on wire and funds transfer. This includes wire and fund transfer conducted by the bank and transactions
conducted by the bank when it is an agent of a money remittance company.

P: OCCASSIONAL/ONE-OFF TRANSACTIONS WITH WALK IN CUSTOMERS (THOSE NOT CUSTOMERS OF THE BANK)
Banks should provide information on transactions conducted with 'walk-in' or non-bank customers.

Q: SUSPICIOUS TRANSACTION REPORTS

Banks should provide information on suspicious transaction reports. Firstly banks should provide information on the number of suspicious
transactions reports submitted to the FIU. Banks should also provide information on suspicious transaction reports that are still under review
by the bank's Compliance officer pending determining whether or not to submit the report to the FIU. Finally banks should report the number
of suspicious transaction reports that it has determined not to submit to the FIU.

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