Business Risk Assessment

Business Risk Rating Form

Green Country Federal Credit Union For Internal Use Only
Date & Time*
Reason for Assessment*
Business Name:*
Member Number
Tax ID Number
If none indicate if Tax ID is in application process
Tax ID number applied for
Please select*

Business is in good standing with the Secretary of StateRelationship with the credit union is 1 year or lessRelationship with credit union is 2-4 yearsRelationship with credit union is 5-9 yearsRelationship with credit union is 10 years or moreForeign businessBusiness is not in good standing with the credit union
Primary Physical Address*

Street Address

Street Address Line 2

CityState

Zip Code
Office is located in

HIFCAHIDTA
Multiple Locations*

YesNo
Please list trade name and city of each location.
Main office and all locations are located within charter areaSome locations are located outside of our charter area
Company Principal(s)*
Principal(s) is not a U.S. citizenPrincipal(s) is a politically exposed person (PEP) - OFACPrincipal(s) has a good credit union relationship over 1 yearCompany ownership has changed in the past year
Beneficial Owner(S)
Beneficial Owner(s) Verified

YesNo
Does the member anticipate/conduct the following?*

Purchase money instrumentsSending/receiving domestic wire transfersSending/receiving foreign wire transfers
Nature of Business Services (be specific)*
Financial Institution (does not qualify as an MSB)ATM owner/operatorCash-Intensive business (requires manager approval)None of the above
Cash-intensive businesses are more easily misused by money launderers to legitimize their illicit proceeds. Examples of higher risk entities include, but are not limited to:
- Investment companies
- Restaurants
- Cigarette distributors
- Parking garages
- Casinos, card clubs
- Car, boat & plane dealers
- Ship, bus & plane operators
- Convenience stores
- Liquor stores
- Vending machine operators
- Jewelry store, gem dealers
- Privately-owned ATMs
Calculated Risk
LOW RISK = 5 or Below

MODERATE RISK = 6-15

HIGH RISK = 16 or above
Deposit Activity
New Account
(list total deposit amount)
Source of Funds:

CheckCashInternal Transfer
Average Monthly Deposits
select all that apply

CashChecksACHRemote Deposit CapturePurchase of money orders/corp checksATM Deposits
Withdrawal Activity
Average Monthly Withdrawals
select all that apply

CashChecksACHPurchase of money orders/corp checksATM Withdrawal
Any additional comments or information:
Money Service Business Test

If you answer yes to any of the following, the service is not available, do not open account.
Do you perform money transfer services?

YesNo
Do you cash checks?

YesNo
Do you sell money orders?

YesNo
Do you sell travelers checks?

YesNo
Do you sell stored-value cards?

YesNo
Is your business involved in internet gambling activites?

YesNo
Risk Assessment completed by:

First NameLast Name
Branch
Should be Empty:

Business Risk Rating Form

Deposit Activity

Withdrawal Activity

Money Service Business Test