DEPARTMENT OF THE TREASURY OMB NO.

1506-0014
FINANCIAL CRIMES ENFORCEMENT NETWORK
orm 105 (Formerly Customs Form 4790) (Rev. July 2003) REPORT OF INTERNATIONAL
Department of the Treasury FinCEN
TRANSPORTATION OF CURRENCY
OR MONETARY INSTRUMENTS
Please type or print. 31 U.S.C. 5316; 31 CFR 103.23 and 103.27
FOR A PERSON DEPARTING OR ENTERING THE UNITED STATES, OR A PERSON SHIPPING, MAILING, OR RECEIVING CURRENCY OR
PART I MONETARY INSTRUMENTS. (IF ACTING FOR ANYONE ELSE, ALSO COMPLETE PART II BELOW.)
1. NAME (Last or family, first, and middle) 2. IDENTIFICATION NO. (See instructions) 3. DATE OF BIRTH (Mo./Day/Yr.)

4. PERMANENT ADDRESS IN UNITED STATES OR ABROAD 5. YOUR COUNTRY OR COUNTRIES OF CITIZENS

6. ADDRESS WHILE IN THE UNITED STATES 7. PASSPORT NO. & COUNTRY

8. U.S. VISA DATE (Mo./Day/Yr.) 9. PLACE UNITED STATES VISA WAS ISSUED 10. IMMIGRATION ALIEN NO.

11. IF CURRENCY OR MONETARY INSTRUMENT IS ACCOMPANIED BY A PERSON, COMPLETE 11a OR 11b

A. EXPORTED FROM THE UNITED STATES B. IMPORTED INTO THE UNITED STATES
Departed From: (U.S. Port/City in U.S.) Arrived At: (Foreign City/Country) Departed From: (Foreign City/Country) Arrived At: (City in U.S.)

12. IF CURRENCY OR MONETARY INSTRUMENT WAS MAILED OR OTHERWISE SHIPPED, COMPLETE 12a THROUGH 12f
12a. DATE SHIPPED (Mo./Day/Yr.) 12b. DATE RECEIVED (Mo./Day/Yr.) 12c. METHOD OF SHIPMENT (e.g. u.s. Mail, Public Carrier, etc.) 12d. NAME OF CARRIER

12e. SHIPPED TO (Name and Address)

12f. RECEIVED FROM (Name and Address)

PART INFORMATION ABOUT PERSON(S) OR BUSINESS ON WHOSE BEHALF IMPORTATION OR EXPORTATION WAS CONDUCTED
13. NAME (Last or family, first, and middle or Business Name)

14. PERMANENT ADDRESS IN UNITED STATES OR ABROAD

15. TYPE OF BUSINESS ACTIVITY, OCCUPATION, OR PROFESSION 15a. IS THE BUSINESS A BANK?
Yes No

P A R T III CURRENCY AND MONETARY INSTRUMENT INFORMATION (SEE INSTRUCTIONS ON REVERSE)(To be completed by everyone)
16. TYPE AND AMOUNT OF CURRENCY/MONETARY INSTRUMENTS 17. IF OTHER THAN U.S.
CURRENCY IS INVOLVED, PLEASE
COMPLETE
Currency and Coins $ BLOCKS A AND B.
A. Currency Name
Other Monetary Instruments
(Specify type, issuing entity and date, and serial or other identifying number.) $
B. Country
(TOTAL) $
P A R T IV SIGNATURE OF PERSON COMPLETING THIS REPORT
Under penalties of perjury, I declare that I have examined this report, and to the best of my knowledge and belief it is true, correct and complete.

18. NAME AND TITLE (Print) 19. SIGNATURE 20. DATE OF REPORT (Mo./Day/Yr.)

COUNT VERIFIED VOLUNTARY

CUSTOMS AND BORDER PROTECTION USE ONLY REPORT
Yes No Yes No
DATE AIRLINE/FLIGHT/VESSEL LICENSE PLATE INSPECTOR (Name and Badge Number)
STATE/COUNTRY NUMBER

FinCEN FORM
105
(Formerly Customs Form
GENERAL INSTRUCTIONS savings association, savings and loan association, and building and loan
This report is required by 31 U.S.C. 5316 and Treasury Department regulations association organized under the laws of any State or of the United States; (4)
(31 CFR 103). an insured institution as defined in section 401 of the National Housing Act; (5)
a savings bank, industrial bank or other thrift institution; (6) a credit union
WHO MUST FILE: organized under the laws of any State or of the United States; (7) any other
(1) Each person who physically transports, mails, or ships, or causes to organization chartered under the banking laws of any State and subject to the
be physically transported, mailed, or shipped currency or other monetary supervision of the bank supervisory authorities of a State other than a money
instruments in an aggregate amount exceeding $10,000 at one time from the service business; (8) a bank organized under foreign law; and (9) any
United States to any place outside the United States or into the United national banking association or corporation acting under the provisions of
States from any place outside the United States, and section 25A of the Federal Reserve Act (12 U.S.C. Sections 611-632).

(2) Each person who receives in the United States currency or other Foreign Bank—A bank organized under foreign law, or an agency, branch or
monetary instruments In an aggregate amount exceeding $10,000 at one office located outside the United States of a bank. The term does not include
time which have been transported, mailed, or shipped to the person from an agent, agency, branch or office within the United States of a bank
any place outside the United States. organized under foreign law.

A TRANSFER OF FUNDS THROUGH NORMAL BANKING PROCEDURES, Broker or Dealer in Securities—A broker or dealer in securities, registered
WHICH DOES NOT INVOLVE THE PHYSICAL TRANSPORTATION OF or required to be registered with the Securities and Exchange Commission
CURRENCY OR MONETARY INSTRUMENTS, IS NOT REQUIRED TO BE under the Securities Exchange Act of 1934.
REPORTED. Identification Number—Individuals must enter their social security number,
if any. However, aliens who do not have a social security number should enter
Exceptions: Reports are not required to be filed by:
passport or alien registration number. All others should enter their
(1)a Federal Reserve bank, employer identification number.

(2) a bank, a foreign bank, or a broker or dealer in securities in respect Monetary Instruments— (1) Coin or currency of the United States or of any other
to currency or other monetary instruments mailed or shipped through the country,
postal service or by common carrier, (2) traveler’s checks in any form, (3) negotiable instruments (including checks,
promissory notes, and money orders) in bearer form, endorsed without
(3) a commercial bank or trust company organized under the laws of any restriction, made out to a fictitious payee, or otherwise in such form that
State or of the United States with respect to overland shipments of currency or title thereto passes upon delivery, (4) incomplete instruments (including
monetary instruments shipped to or received from an established customer checks, promissory notes, and money orders) that are signed but on which the
maintaining a deposit relationship with the bank, in amounts which the bank name of the payee has been omitted, and (5) securities or stock in bearer
may reasonably conclude do not exceed amounts commensurate with the form or otherwise in such form that title thereto passes upon delivery.
customary conduct of the business, industry, or profession of the customer Monetary instruments do not include (i) checks or money orders made
concerned, payable to the order of a named person which have not been endorsed or
which bear restrictive endorsements,
(4) a person who is not a citizen or resident of the United States in
(ii) warehouse receipts, or (iii) bills of lading.
respect to currency or other monetary instruments mailed or shipped from
abroad to a bank or broker or dealer in securities through the postal Person—An individual, a corporation, a partnership, a trust or estate, a
service or by common carrier, joint stock company, an association, a syndicate, joint venture or other
unincorporated organization or group, an Indian Tribe (as that term is defined
(5) a common carrier of passengers in respect to currency or other
in the Indian Gaming Regulatory Act), and all entities cognizable as legal
monetary instruments in the possession of its passengers,
personalities.
(6) a common carrier of goods in respect to shipments of currency or SPECIAL INSTRUCTIONS:
monetary instruments not declared to be such by the shipper,
You should complete each line that applies to you. PART I. — Block 12A and
(7) a travelers’ check issuer or its agent in respect to the transportation 12B; enter the exact date you shipped or received currency or monetary
of travelers’ checks prior to their delivery to selling agents for eventual instrument(s). PART II. -Block 13; provide the complete name of the shipper or
sale to the public, recipient on whose behalf the exportation or importation was conducted. PART
III. — Specify type of instrument, issuing entity, and date, serial or other
(8)a person with a restrictively endorsed traveler’s check that is in the identifying number, and payee (if any). Block 17, if currency or monetary
collection instruments of more than one country is involved, attach a list showing each
type, country or origin and amount.
and reconciliation process after the traveler’s check has been negotiated, nor by
(9) a person engaged as a business in the transportation of currency, be subject to seizure and forfeiture. See 31 U.S.C.5321 and 31 CFR
monetary instruments and other commercial papers with respect to the 103.57; 31 U.S.C. 5322 and 31 CFR 103.59; 31 U.S.C. 5317 and 31 CFR
transportation of currency or other monetary instruments overland between 103.58, and U.S.C. 5332.
established offices of banks or brokers or dealers in securities and foreign
persons. DEFINITIONS:
Bank—Each agent, agency, branch or office within the United States of any
WHEN AND WHERE TO FILE: person doing business in one or more of the capacities listed: (1) a commercial
A. Recipients—Each person who receives currency or other monetary bank or trust company organized under the laws of any State or of the
instruments in the United States shall file FinCEN Form 105, within 15 days United States; (2) a private bank; (3) a
after receipt of the currency or monetary instruments, with the Customs
officer in charge at any port of entry or departure or by mail with the
Commissioner of Customs, Attention: Currency Transportation Reports,
Washington DC 20229.
B.Shippers or Mailers—lf the currency or other monetary instrument does not
accompany the person entering or departing the United States, FinCEN
Form 105 may be filed by mail on or before the date of entry, departure,
mailing, or shipping with the Commissioner of Customs, Attention: Currency
Transportation Reports, Washington DC 20229.
C. Travelers—Travelers carrying currency or other monetary instruments with
them shall file FinCEN Form 105 at the time of entry into the United States or
at the time of departure from the United States with the Customs officer in
charge at any Customs port of entry or departure.
An additional report of a particular transportation, mailing, or shipping of
currency or the monetary instruments is not required if a complete and
truthful report has already been filed. However, no person otherwise
required to file a report shall be excused from liability for failure to do so if,
in fact, a complete and truthful report has not been filed. Forms may be
obtained from any Bureau of Customs and Border Protection office.
PENALTIES: Civil and criminal penalties, including under certain
circumstances a fine of not more than $500,000 and Imprisonment of not
more than ten years, are provided for failure to file a report, filing a report
containing a material omission or misstatement, or filing a false or
fraudulent report. In addition, the currency or monetary instrument may
FinCEN FORM
105
(Formerly Customs Form
 PRIVACY ACT AND PAPERWORK REDUCTION ACT NOTICE:
Pursuant to the requirements of Public law 93-579 (Privacy Act of 1974),
notice is hereby given that the authority to collect information on Form 4790
in accordance with 5 U.S.C. 552a(e)(3) is Public law 91-508; 31 U.S.C. 5316; 5
U.S.C. 301; Reorganization Plan No.1 of 1950; Treasury
Department Order No. 165, revised, as amended; 31 CFR 103; and 44 U.S.C.
3501.
The principal purpose for collecting the information is to assure maintenance
of reports or records where such reports or records have a high degree of
usefulness in criminal, tax, or regulatory investigations or proceedings. The
information collected may be provided to those officers and employees of the
Bureau of Customs and Border Protection and any other constituent unit of the
Department of the Treasury who have a need for the records in the
performance of their duties. The records may be referred to any other
department or agency of the Federal Government upon the request of the
head of such department or agency. The information collected may also be
provided to appropriate state, local, and foreign criminal law enforcement and
regulatory personnel in the performance of their official duties.
Disclosure of this information is mandatory pursuant to 31 U.S.C. 5316 and
31 CFR Part 103. Failure to provide all or any part of the requested
information may subject the currency or monetary instruments to seizure and
forfeiture, as well as subject the individual to civil and criminal liabilities.
Disclosure of the social security number is mandatory. The authority to
collect this number is 31 U.S.C. 5316(b) and 31 CFR 103.27(d). The social
security number will be used as a means to identify the individual who files
the record.
An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently valid OMB
control number. The collection of this information is mandatory pursuant to 31
U.S.C. 5316, of Title II of the Bank Secrecy Act, which is administered by
Treasury’s Financial Crimes Enforcement Network (FINCEN).
Statement required by 5 CFR 1320.8(b)(3)(iii): The estimated average burden
associated with this collection of information is 11 minutes per respondent or
record keeper depending on individual circumstances. Comments concerning
the accuracy of this burden estimate and suggestions for reducing this
burden should be directed to the Department of the Treasury, Financial
Crimes Enforcement Network, P.O. Box 39 Vienna, Virginia 22183. DO NOT
send completed forms to this office—See When and Where To File above.

FinCEN FORM
105
(Formerly Customs Form