1. I-2 RISK ASSESSMENTS FOR FINANCIAL INSTITUTIONS
8/13
BSA/AML QUANTITY OF RISK SUMMARY FORM
BSA/AML Quantity of Risk Summary Form (rev. 6/30/04)
Bank:
Charter Number:
City: State:
and County:
As of Date:
Total Assets (000’s):
EIC Name:
Bank Contact Person and Phone: Supervisory Office:
Higher-risk Areas of the Bank:
Number of retail
transactions
(actual number)
Dollar total of
retail
transactions
(thousands)
Unknown,1
Estimated
or Verified
Wire Transfer Department: (average daily volume)2
Domestic Wires Unknown
Payable Upon Proper ID (PUPID) Activity: Unknown
International Wires (includes wire remittances) Unknown
High Risk Location (sending and receiving) 3
: None Unknown
None Unknown
None Unknown
None Unknown
None Unknown
Other Unknown
Other Unknown
Number of Accounts
(actual number)
Total Dollars of
all Accounts
(thousands)
Unknown,
Estimated
or Verified
Trust Department:
Charitable Trusts and Foundations (Foreign & Domestic) 4
Unknown
Customer Directed (non-discretionary) Accounts Unknown
Custodial Accounts Unknown
Investment Advisory Accounts Unknown
Revocable Trusts Unknown
Foreign Grantor or beneficiaries Unknown
Loans or Closely held corporations Unknown
Private Banking Department:
Domestic Customers only Unknown
International Customers (total) Unknown
Geographic focus: None Unknown
None Unknown
None Unknown
None Unknown
None Unknown
Other Unknown
Other Unknown
International Department:
Geographic focus: None Unknown
None Unknown
None Unknown
Other Unknown

2. Assessing the Risk of Banking Operations I-3
8/13
Politically Exposed Persons (PEPs):5
Geographic focus: None Unknown
None Unknown
None Unknown
None Unknown
None Unknown
Other Unknown
Other Unknown
Correspondent Accounts with Foreign Banks:
Geographic focus: None Unknown
None Unknown
None Unknown
None Unknown
None Unknown
Other Unknown
Other Unknown
Pouch Services6
with Foreign Institutions, Persons and / or Businesses:
Geographic focus: None Unknown
None Unknown
None Unknown
None Unknown
Other Unknown
Other Unknown
Brokerage Department / Operations:
Unknown
Investment Advisory / Management:
Unknown
International Branch Facility: (if yes, locations)
None Unknown
Other Unknown
Other Unknown
Higher-risk Products and Services:
Number of retail
transactions
(actual number)
Dollar total of
retail
transactions
(thousands)
Unknown,
Estimated
or Verified
Issuance of travelers checks, official bank checks, and money orders 7
(Average daily volume)
Unknown
Payable Through Accounts 8
(identify which countries)
None Unknown
None Unknown
None Unknown
None Unknown
Other Unknown
Other Unknown
Special Use or Concentration Accounts 9
(e.g.: intra-day, suspense, etc.)
Unknown

3. I-4 RISK ASSESSMENTS FOR FINANCIAL INSTITUTIONS
8/13
Higher-risk Accounts (Deposit)
Number of Accounts
(actual number)
Outstanding
balance of all
Accounts
(thousands)
Unknown,
Estimated
or Verified
Estimated number and dollar volume of accounts opened through the
Internet, Mails, Wire, or by Phone (Non-branch)
Unknown
Money Service Businesses (MSBs): Unknown
Casas de Cambios / Currency Exchanges (Foreign) Unknown
Currency Exchanges (Domestic) Unknown
Money transmitters (includes incidental to other retail business) Unknown
Check Cashing (includes incidental to other retail business) Unknown
Smart Cards, e-cash (Issuance of electronic products that permit
the rapid movement of currency)
Unknown
Cash-intensive businesses (i.e. Convenience stores, Liquor Stores,
Restaurants, & Truck Stops):
Unknown
Foreign (off-shore) Corporations with transaction accounts (total): Unknown
List Countries of offshore corporations: None Unknown
None Unknown
None Unknown
Other Unknown
Non-resident Alien Accounts: Unknown
List Countries of citizenship for NRAs: None Unknown
None Unknown
Other Unknown
Charitable Organizations (Foreign & Domestic) (see footnote 3): Unknown
Jewelry, Gem, and Precious metal dealers (retail and wholesale)
Unknown
Travel agencies
Unknown
Import / export companies
Unknown
Casinos
Unknown
Stock Brokerage firms (Broker dealers)
Unknown
Other high-risk accounts or products not itemized above10
: Other
Unknown
Other Unknown
CTR/SAR data and Optional Examiner feedback:
Estimated Currency Transaction Report (CTR) and
Suspicious Activity Report (SAR) volumes for the
previous 12 months.
CTR Volume (12 months)
0
SAR Volume (12 months)
0
Bank’s and/or Examiner’s comments regarding the
Compliance and Reputation risk associated with
BSA/AML (High, Medium, or Low). We also
encourage comments on the quality of the bank’s
BSA/AML risk management system.
Unknown quantity of risk
Unknown quality of risk management
Unknown direction
Comments:
Optional: Feedback/ suggestions on ways to improve
this Risk Assessment form, and our analysis of
BSA/AML Compliance and Reputation risk:
Comments: