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Form 3774

Suspected Counterfeit Bank Notes & Forged Payment Cards

Purpose

This form is to be used only by financial institutions, retail businesses and police agencies when a passer is not present. In the event that the passer is present, contact local police immediately.

Utilization of this form will assist in the disposition of suspected counterfeit bank notes in an effective and efficient manner.

Directions for Financial Institutions

  • This form must be completed by the financial institution with all available pertinent information recorded.
  • If the source of the bank note is known, the information provided should be as detailed as possible.
  • The bank note should be attached to this form and turned over to the local police as soon as possible. The method used to forward the bank note to the police will be determined by the police in your jurisdiction.
  • In cases where multiple bank notes are received, a single form can be completed provided that the source of the bank note and the time frame during which it was passed are similar.
  • It is very important to record the date on which the suspected counterfeit bank note was first detected.

Suspected counterfeit bank notes identified at the financial institution's Central Cash Operations Centre should either be sent back to the police agency with primary jurisdiction or to the originating financial institution for proper disposition to that police agency. In such cases, it is imperative that this form be utilized and that the identity and address of the financial institution connected to the bank note be properly recorded. For bank notes received at the Central Cash Operations Centre where the source cannot be established, these bank notes should be forwarded to the police agency in that jurisdiction.

Directions for Law Enforcement Agencies

  • Police agencies are requested to submit suspected counterfeit bank notes received from financial institutions or retail businesses together with a completed form, to the National Anti-Counterfeiting Bureau in Ottawa as soon as possible.
  • The National Anti-Counterfeiting Bureau will only accept bank notes from police agencies and a police occurrence or case report number must be included.
  • Police agencies may use discretion as to the manner in which bank notes are to be received from financial institutions or retail businesses. Many larger police agencies have made arrangements with financial institutions or retail businesses whereby the completed forms and bank notes are dropped off at the police agencies for onwards transmission to the National Anti-Counterfeiting Bureau.

Directions for Retail Businesses

  • This form must be completed by the retail business with all available pertinent information recorded.
  • The bank note should be attached to this form and turned over to the local police as soon as possible. The method used to forward the bank note to the police will be determined by the police in your jurisdiction.
  • In cases where multiple bank notes are received, a single form can be completed provided that the source of the bank note and the time frame during which it was passed are similar.
  • It is very important to record the date on which the suspected counterfeit bank note was first detected.

Forged Payment Cards

It is requested that this form also be used when suspected forged payment cards are turned in or seized by financial institutions or retail businesses. In such cases, a completed form and the payment card should be sent to the card company for recording and disposition. If the user of the card is present, call local police immediately.