Suspicious Activity Report - Branch Escalation Form

1. Section 1: Account & Customer Identification Details

This section captures essential identification details for all parties involved in the suspicious activity. Accurate and complete information is critical for effective investigation and regulatory reporting.


Branch Code

Staff Member ID Number

Staff Member Full Name

Staff Role


Date of Incident Observation

Time of Incident Observation


Is the customer physically present at the branch?


Customer Full Legal Name

Customer Primary Identification Number

Primary ID Type

Customer Date of Birth

Customer Contact Number

Customer Address on File

Account Number(s) Involved

Account Type(s)

Account Status at Time of Incident

Reporter's Relationship to Account




Are multiple customers or accounts involved in this incident?


2. Section 2: Type of Suspicious Activity & Transaction Channel

Classify the suspicious activity and document transaction details. Precise categorization enables accurate risk assessment and appropriate investigative resource allocation.


Primary Suspicious Activity Category









Transaction Channel(s) Involved

Transaction Amount

Transaction Currency


Transaction Date

Transaction Time


Are there multiple transactions involved in this incident?


Geographic Location of Transaction

Product or Service Involved

3. Section 3: Red Flags & Supporting Evidence Log

Document all observable red flags and collect supporting evidence. Thorough documentation strengthens the investigation and supports potential regulatory reporting obligations.


Red Flags Observed

Description of Other Red Flags

Detailed Description of Suspicious Behavior or Transaction

Types of Evidence Available

Upload Documentary Evidence (ID documents, forms, letters, etc.)

Choose a file or drop it here
 

Upload Photographic Evidence (suspicious individuals, documents, devices, etc.)

Choose a file or drop it here

Were there witnesses to the incident?


Did the customer provide an explanation for the activity?


Plausibility Assessment of Customer Explanation (if provided)

Does this activity deviate from the customer's historical transaction pattern?


4. Section 4: Immediate Account Hold & System Actions Taken

Document all immediate actions taken to mitigate risk and secure assets. Prompt action can prevent further losses and preserve evidence.


Was an immediate account hold or restriction placed?


Systems Accessed to Take Action

Detailed Actions Taken in Systems

Was law enforcement notified immediately?


Was the customer notified of the hold or restriction?


Was your immediate supervisor notified?


5. Section 5: Compliance & Financial Crime Unit Sign-Off

Final assessment and escalation to Financial Crime Unit for investigation and regulatory reporting determination. This section must be completed by authorized compliance personnel.


Escalation Priority Level

Overall Risk Assessment

Recommended Next Actions

Assigned Compliance Officer

Financial Crime Unit Review Comments

Teller/Staff Member Signature

Supervisor Verification Signature

FCU Receiving Officer Signature

Form Status

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