Division Form 3—Application to issue extension no - Anti-Money Laundering and Counter-Terrorism Financing Rules 2025 - Form 3—Application to issue extension notice

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Form 3—Application to issue extension notice

APPLICATION TO ISSUE EXTENSION NOTICE TO FURTHER EXTEND THE PERIOD OF A KEEP OPEN NOTICE

Paragraph 39B(8)(b) of the Anti‑Money Laundering and Counter‑Terrorism Financing Act 2006

This is the prescribed form for an application to the AUSTRAC CEO under paragraph 39B(8)(b) of the Anti‑Money Laundering and Counter‑Terrorism Financing Act 2006 (the AML/CTF Act) to disapply paragraph 39B(7)(b) of that Act for the purpose of issuing a further extension notice in relation to a keep open notice.

Full name of reporting entity to whom the keep open notice was issued

Commencement date of the keep open notice

<table cellspacing="0" cellpadding="0" style="width:100%; border:0.75pt solid #000000; border-collapse:collapse"><tbody><tr><td colspan="2" style="border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top; background-color:#000000"><p class="TableHeading"><span style="color:#ffffff">Previous extension notices issued under subsection</span><span style="color:#ffffff"> </span><span style="color:#ffffff">39B(7) of the AML/CTF Act</span></p></td></tr><tr><td style="width:50%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="Tabletext"><span>How many extension notices have been issued in relation to the keep open notice prior to this application?</span></p><p class="Tabletext"><span></span></p></td><td style="width:50%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="Tabletext"><span></span></p></td></tr></tbody></table>

<table cellspacing="0" cellpadding="0" style="width:100%; border:0.75pt solid #000000; border-collapse:collapse"><tbody><tr><td colspan="2" style="border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top; background-color:#000000"><p class="TableHeading"><span style="color:#ffffff">Previous applications to the AUSTRAC CEO</span></p></td></tr><tr><td style="width:50%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="Tabletext"><span>How many notices have been given by the AUSTRAC CEO under paragraph</span><span> </span><span>39B(8)(d) of the AML/CTF Act in relation to the keep open notice?</span></p></td><td style="width:50%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p class="Tabletext"><span></span></p></td></tr></tbody></table>

<table cellspacing="0" cellpadding="0" style="width:100%; border:0.75pt solid #000000; border-collapse:collapse"><tbody><tr><td colspan="2" style="border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top; background-color:#000000">Details of the customer(s) to whom the keep open notice appliesList all customers included in the keep open notice</td></tr><tr><td style="width:50%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">Full name of customer(s)</td><td style="width:50%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">Date of birth or Australian Business Number/Australian Company Number (if known)</td></tr><tr><td style="width:50%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"></td><td style="width:50%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"></td></tr><tr><td style="width:50%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"></td><td style="width:50%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"></td></tr><tr><td style="width:50%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"></td><td style="width:50%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"></td></tr></tbody></table>