Detail No.

Name

Content

1

2

3

1. Data on form of data and information on the transaction which is subject to financial monitoring (further – the FM-1) form

1.1

Number of the FM-1 form *

1. Number: 2. Communication with other FM-1 form (in the presence):

2.1. Number of the connected FM-1 form:

2.2. Date of the connected FM-1 form:

1.2

Date of the FM-1 form *

1.3

Message type

(necessary to choose) *

1. New message

2. Adjustment of the unaccepted message

(with indication of number of the adjusted message)

3. Request of replacement of the message

(with indication of number of the message)

1.4

Transaction condition (necessary to choose)

1. It is made (transaction completion time)

2. It is not made - refusal in carrying out

3. It is not made – for decision making

4. The message on taking measures to freezing of transaction with money or other property

1.4-1

Date and time of making of transaction

1.5

The basis for submission of the message (necessary to choose) *

1. It is equal or exceeds the threshold amount

2. Suspicious transaction

3. The field is not active

4. Coincidence of participants of transaction to the list of the organizations and faces tied with financing of terrorism and extremism:

4.1 Suspension of account transactions according to bank accounts

4.2 Suspension of execution of instructions for payments and transfers without use of the bank account

4.3 Blocking of securities

4.4 Refusal in carrying out other transactions

4.5 Refusal in carrying out transaction on implementation of insurance payment, on return of insurance premium or its part in case of early termination of the insurance contract and remuneration in case of early termination the insurer of the service provision agreement of broker activities

4.6 Payments of means to the physical person included in the list of the organizations and faces tied with financing of terrorism and extremism according to the legislation of RK

4.7. Repayment according to the loan agreement

5. The field is not active

6. The field is not active

7. The field is not active

8. The transactions for obligatory studying recognized as suspicious subjects of financial monitoring with fixation of results of such studying

9. The transactions having the characteristics corresponding to tipologiya, schemes and methods of financing of terrorism, extremism

10. The transactions having the characteristics corresponding to tipologiya, schemes and methods of legalization (washing) of the criminal income

11. Coincidence of participants of transaction to the list of the organizations and faces tied with financing of distribution of weapons of mass destruction

11.1 Suspension of account transactions according to bank accounts

11.2 Suspension of execution of instructions for payments and transfers without use of the bank account

11.3 Blocking of securities

11.4 Refusal in carrying out other transactions

11.5 Refusal in carrying out transaction on implementation of insurance payment, on return of insurance premium or its part in case of early termination of the insurance contract and remuneration in case of early termination the insurer of the service provision agreement of broker activities

11.6 The direction on suspension of the transactions specified in Item 6 of article 12-1 of the Law

12. Refusal in establishment of business relations:

12.1 In case of impossibility of taking measures, provided by subitems 1), 2), 2-1), 2-2) and 4) of Item 3 of article 5 of the Law

12.2 In case of availability of suspicions that business relations are used by the client for the purpose of legalization (washing) of income gained in the criminal way

12.3 In case of availability of suspicions that business relations are used by the client for the purpose of terrorism financing

13. Refusal in carrying out transaction:

13.1 In case of impossibility of taking measures, provided by subitems 1), 2), 2-1), 2-2), 4) and 6) Item 3 of article 5 of the Law

13.2 In case of availability of suspicions that business relations are used by the client for the purpose of legalization (washing) of income gained in the criminal way

13.3 In case of availability of suspicions that business relations are used by the client for the purpose of terrorism financing

14. Termination of business relations:

14.1 In case of availability of suspicions that business relations are used by the client for the purpose of legalization (washing) of income gained in the criminal way

14.2 In case of availability of suspicions that business relations are used by the client for the purpose of terrorism financing

2. The information about the subject of financial monitoring who directed the FM-1 form

2.1

Code of the subject of financial monitoring *

2.2

Subject of financial monitoring *

1.1. Organizational form:

1.2. Name:

1.2.1. Surname:

1.2.2. Name:

1.2.3. Middle name (in the presence):

2.3

The detail is not active

2.4

Individual identification number / business and identification number (further – IIN/the BIN) *

2.5

Location address *

1. Area (including cities of republican value and capital):

2. Area:

3. Settlement (city/settlement/village), except for cities of republican value and capital:

4. Name of the street/prospectus/residential district:

5. House number:

6. Number of apartment/office (in the presence):

7. Postal index:

2.6

The identity document (for physical persons)

2.6.1

Number and series of the identity document (for physical persons)

1. Number:

2. Series (in the presence):

2.6.2

Who issues the identity document (for physical persons)

2.6.3

When the identity document is issued (for physical persons)

2.7

Ranking officer

1. Surname:

2. Name:

3. Middle name (in the presence):

2.7.1

Position of the ranking officer

2.8

Contact telephone numbers *

2.9

E-mail *

3

Information on the transaction which is subject to financial monitoring

3.1

Transaction number *

3.2

Transaction type code *

1. Code:

2. Information on the property which is subject to state registration:

2.1. Property type:

2.2. Registration number of property / cadastral number

2.2.1. ISIN *

2.2.2. CFI

3.2.1.

First additional code of transaction type

3.2.2.

Second additional code of transaction type

3.3

Code of purpose of payment *

1. Code of purpose of payment:

2. It is impossible to establish

3.4

Number of participants of transaction *

3.5

Transaction currency code / currency agreement *

3.6

Transaction amount in currency of its carrying out *

3.7

Transaction amount in tenge *

3.7.1.

The amount of the currency agreement in conclusion currency

3.7.2.

Amount of the currency agreement of tenge

3.7.3.

The cost (dirty price) for 1 unit of security in the transaction, in currency of its carrying out

3.7.4.

The cost (dirty price) for 1 unit of security in the transaction, in currency of its carrying out, in tenge

3.8

Transaction making basis *

3.9

Date and document number based on which transaction is performed

1. Date:

2. Document number:

3.10

Code of sign of suspiciousness of transaction

3.11

1st additional code of sign of suspiciousness of transaction

3.12

2nd additional code of sign of suspiciousness of transaction (in the presence)

3.13

The description of the arisen difficulties of qualification of transaction as suspicious

3.14

The additional information on transaction

3.15

Address of the place of making of transaction *

- online

- offline *

3.16

The venue of the transaction (it is necessary to choose) *:

1. Organized market of securities

2. Unorganized market of securities

3. Other (not established by the Law of the Republic of Kazakhstan "About the security market"

3.17

The number of the securities realized in the transaction *

4. The information about participants of the transaction which is subject to financial monitoring

4.1

Participant

(necessary to choose) *

1. The payer on transaction

2. The receiver on transaction

3. The representative, person for and on behalf of the payer

4. The representative, person for and on behalf of the receiver

5. The beneficiary from the payer

6. The beneficiary from the receiver

7. Insured

4.2

Client of the subject of financial monitoring

(necessary to choose) *

1. Is not

2. Is

4.3

Type of the participant *

4.4

Residence *

4.4.1.

Nationality *