{"id":3599,"date":"2026-05-13T07:30:59","date_gmt":"2026-05-13T07:30:59","guid":{"rendered":"https:\/\/demo.ignitedigitalcc.com\/fic\/?page_id=3599"},"modified":"2026-05-13T12:14:27","modified_gmt":"2026-05-13T12:14:27","slug":"form-suspicious-transaction-report-str","status":"publish","type":"page","link":"https:\/\/demo.ignitedigitalcc.com\/fic\/external-suspicious-activity-reports\/form-suspicious-transaction-report-str\/","title":{"rendered":"Form &#8211; Suspicious Activity Report (SAR)"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3599\" class=\"elementor elementor-3599\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-03242c7 e-flex e-con-boxed e-con e-parent\" data-id=\"03242c7\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;gradient&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-06186b3 e-con-full e-flex e-con e-child\" data-id=\"06186b3\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b8ed283 elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"b8ed283\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeInDown&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Form &#8211; Suspicious Activity Report (SAR)<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-6caf992 e-flex e-con-boxed e-con e-parent\" data-id=\"6caf992\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-edb8a15 e-con-full e-flex e-con e-child\" data-id=\"edb8a15\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8de88ca elementor-widget elementor-widget-heading\" data-id=\"8de88ca\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h5 class=\"elementor-heading-title elementor-size-default\">Fill out the form below to submit a report for an SAR<\/h5>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-16ac9d1 elementor-widget elementor-widget-text-editor\" data-id=\"16ac9d1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Complete as much of this form as possible. Please replicate the applicable parts for multiple transactions.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-991fe06 e-con-full e-grid e-con e-child\" data-id=\"991fe06\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-831ec9f e-con-full e-flex e-con e-child\" data-id=\"831ec9f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c994879 elementor-widget elementor-widget-heading\" data-id=\"c994879\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h6 class=\"elementor-heading-title elementor-size-default\">Disclaimer<\/h6>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c8f69dc elementor-widget elementor-widget-text-editor\" data-id=\"c8f69dc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Reporting of suspicious activities and attempted transactions is required under Section 33 of the Financial Intelligence Act (FIA), Act No.13 of 2012, read with Regulation 20, 21 and 22 of FIA.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-235deb8 e-con-full e-flex e-con e-child\" data-id=\"235deb8\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8cf2f8f elementor-widget elementor-widget-heading\" data-id=\"8cf2f8f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h6 class=\"elementor-heading-title elementor-size-default\">Important Information<\/h6>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a9b71be elementor-widget elementor-widget-text-editor\" data-id=\"a9b71be\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>It is an offence i.t.o Section 33(4) and read with Section 46 of the Financial Intelligence Act, Act No.13 of 2012 for any person to either directly or indirectly disclose to any other person that a disclosure has been submitted to the Financial Intelligence Centre.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-feec6e7 e-con-full e-flex e-con e-child\" data-id=\"feec6e7\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-bbf8909 elementor-widget elementor-widget-heading\" data-id=\"bbf8909\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h6 class=\"elementor-heading-title elementor-size-default\">For Further Information, Contact:<\/h6>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fd8f6a3 elementor-widget elementor-widget-text-editor\" data-id=\"fd8f6a3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>FIC Helpdesk at 061 283 5287\/5100 or via e-mail at: <a href=\"mailto:helpdesk@fic.na\">helpdesk@fic.na<\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-f8570d1 e-con-full e-flex e-con e-child\" data-id=\"f8570d1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-bb96e00 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"bb96e00\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element 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   <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/fic\/wp-json\/wp\/v2\/pages\/3599#gf_1' data-formid='1' novalidate>\n        <div id='gf_progressbar_wrapper_1' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>6<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_16' style='width:16%;'><span>16%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_1_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_1\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">PART A: PARTICULARS OF THE PERSON\/ENTITY SUBMITTING THE REPORT<\/h3><\/div><div id=\"field_1_5\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_5'>Full name Reporting Entity<\/label><div class='gfield_description' id='gfield_description_1_5'>Full name Reporting Entity (If not already registered with the FIC, complete the rest of Part A)<\/div><div class='ginput_container ginput_container_text'><input name='input_5' id='input_1_5' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_5\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_6\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_6'>Entity Registration Number<\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_1_6' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_7\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_7'>Entity Incorporation City<\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_1_7' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_8\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_8'>Entity Incorporation Country<\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_1_8' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_9\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_9'>Operating Street Address<\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_1_9' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_10\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">PARTICULARS OF THE COMPLIANCE OFFICER:<\/h3><\/div><div id=\"field_1_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_11'>First Name<\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_1_11' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_12'>Last Name<\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_1_12' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_13\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_13'>Nationality<\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_1_13' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_15\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_15'>ID Number<\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_1_15' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_16\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_16'>Telephone Number<\/label><div class='gfield_description' id='gfield_description_1_16'>With area code<\/div><div class='ginput_container ginput_container_phone'><input name='input_16' id='input_1_16' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_1_16\"  \/><\/div><\/div><div id=\"field_1_17\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_17'>Cellphone Number<\/label><div class='gfield_description' id='gfield_description_1_17'>With area code<\/div><div class='ginput_container ginput_container_phone'><input name='input_17' id='input_1_17' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_1_17\"  \/><\/div><\/div><div id=\"field_1_18\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_18'>Postal Address<\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_1_18' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_19\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_19'>Street Address<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_1_19' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_1_20' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_2' class='gform_page' data-js='page-field-id-20' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_21\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">PART B: DESCRIPTION OF THE SUSPICIOUS ACTIVITY\/ATTEMPTED TRANSACTIONS<\/h3><\/div><div id=\"field_1_22\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_22'>Suspicious Activity\/Transaction Description<\/label><div class='gfield_description' id='gfield_description_1_22'>Describe clearly and completely the facts or unusual circumstances or grounds that led to the suspicion of the attempted transaction or activity.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_22' id='input_1_22' class='textarea large'  aria-describedby=\"gfield_description_1_22\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_1_23\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">PART C: DESCRIPTION OF THE ACTION TAKEN<\/h3><\/div><div id=\"field_1_24\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_24'>Action Taken<\/label><div class='gfield_description' id='gfield_description_1_24'>Describe clearly and completely what action was or will be taken after the suspicion was formed.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_24' id='input_1_24' class='textarea large'  aria-describedby=\"gfield_description_1_24\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_1_25\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">PART D: REPORT INDICATORS<\/h3><\/div><fieldset id=\"field_1_26\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_2col gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Report Indicators<\/legend><div class='gfield_description' id='gfield_description_1_26'>Select more than one if applicable<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_26'><div class='gchoice gchoice_1_26_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.1' type='checkbox'  value='ACTIVITY DOES NOT MATCH CLIENT PROFILE'  id='choice_1_26_1'   aria-describedby=\"gfield_description_1_26\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_1' id='label_1_26_1' class='gform-field-label gform-field-label--type-inline'>ACTIVITY DOES NOT MATCH CLIENT PROFILE<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.2' type='checkbox'  value='ILLICIT TRAFFICKING IN STOLEN AND OTHER GOODS'  id='choice_1_26_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_2' id='label_1_26_2' class='gform-field-label gform-field-label--type-inline'>ILLICIT TRAFFICKING IN STOLEN AND OTHER GOODS<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.3' type='checkbox'  value='ADVERSE REPORTS - INTERNATIONAL'  id='choice_1_26_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_3' id='label_1_26_3' class='gform-field-label gform-field-label--type-inline'>ADVERSE REPORTS - INTERNATIONAL<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.4' type='checkbox'  value='INSIDER TRADING AND MARKET MANIPULATION'  id='choice_1_26_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_4' id='label_1_26_4' class='gform-field-label gform-field-label--type-inline'>INSIDER TRADING AND MARKET MANIPULATION<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.5' type='checkbox'  value='ADVERSE REPORTS ON COMMERCIAL DATABASES'  id='choice_1_26_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_5' id='label_1_26_5' class='gform-field-label gform-field-label--type-inline'>ADVERSE REPORTS ON COMMERCIAL DATABASES<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.6' type='checkbox'  value='INVOLVES INTERNATIONAL PEPS'  id='choice_1_26_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_6' id='label_1_26_6' class='gform-field-label gform-field-label--type-inline'>INVOLVES INTERNATIONAL PEPS<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.7' type='checkbox'  value='ADVERSE REPORTS ON LOCAL PRESS'  id='choice_1_26_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_7' id='label_1_26_7' class='gform-field-label gform-field-label--type-inline'>ADVERSE REPORTS ON LOCAL PRESS<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.8' type='checkbox'  value='INVOLVES LOCAL PEPS'  id='choice_1_26_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_8' id='label_1_26_8' class='gform-field-label gform-field-label--type-inline'>INVOLVES LOCAL PEPS<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.9' type='checkbox'  value='APPEAR ON OFAC OR OTHER LIST'  id='choice_1_26_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_9' id='label_1_26_9' class='gform-field-label gform-field-label--type-inline'>APPEAR ON OFAC OR OTHER LIST<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.11' type='checkbox'  value='KIDNAPPING, ILLEGAL RESTRAINT, HOSTAGE-TAKING'  id='choice_1_26_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_11' id='label_1_26_11' class='gform-field-label gform-field-label--type-inline'>KIDNAPPING, ILLEGAL RESTRAINT, HOSTAGE-TAKING<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.12' type='checkbox'  value='ARMS TRAFFICKING'  id='choice_1_26_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_12' id='label_1_26_12' class='gform-field-label gform-field-label--type-inline'>ARMS TRAFFICKING<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.13' type='checkbox'  value='MONEY LAUNDERING'  id='choice_1_26_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_13' id='label_1_26_13' class='gform-field-label gform-field-label--type-inline'>MONEY LAUNDERING<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.14' type='checkbox'  value='AUTOMATED RULES BASED ACCOUNT MONITORING'  id='choice_1_26_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_14' id='label_1_26_14' class='gform-field-label gform-field-label--type-inline'>AUTOMATED RULES BASED ACCOUNT MONITORING<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.15' type='checkbox'  value='MURDER, GRIEVOUS BODILY INJURY (FOR PROFIT)'  id='choice_1_26_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_15' id='label_1_26_15' class='gform-field-label gform-field-label--type-inline'>MURDER, GRIEVOUS BODILY INJURY (FOR PROFIT)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.16' type='checkbox'  value='CORRUPTION\/BRIBERY'  id='choice_1_26_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_16' id='label_1_26_16' class='gform-field-label gform-field-label--type-inline'>CORRUPTION\/BRIBERY<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.17' type='checkbox'  value='PIRACY'  id='choice_1_26_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_17' id='label_1_26_17' class='gform-field-label gform-field-label--type-inline'>PIRACY<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.18' type='checkbox'  value='COUNTERFEITING AND PIRACY OF PRODUCTS'  id='choice_1_26_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_18' id='label_1_26_18' class='gform-field-label gform-field-label--type-inline'>COUNTERFEITING AND PIRACY OF PRODUCTS<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.19' type='checkbox'  value='PROLIFERATION'  id='choice_1_26_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_19' id='label_1_26_19' class='gform-field-label gform-field-label--type-inline'>PROLIFERATION<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.21' type='checkbox'  value='COUNTERFEITING OF CURRENCY'  id='choice_1_26_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_21' id='label_1_26_21' class='gform-field-label gform-field-label--type-inline'>COUNTERFEITING OF CURRENCY<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.22' type='checkbox'  value='ROBBERY'  id='choice_1_26_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_22' id='label_1_26_22' class='gform-field-label gform-field-label--type-inline'>ROBBERY<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.23' type='checkbox'  value='DENOMINATION CONVERSION'  id='choice_1_26_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_23' id='label_1_26_23' class='gform-field-label gform-field-label--type-inline'>DENOMINATION CONVERSION<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.24' type='checkbox'  value='SEXUAL EXPLOITATION\/PROSTITUTION'  id='choice_1_26_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_24' id='label_1_26_24' class='gform-field-label gform-field-label--type-inline'>SEXUAL EXPLOITATION\/PROSTITUTION<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_25'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.25' type='checkbox'  value='SMUGGLING (DIAMONDS, GOLD, MINERALS, PRECIOUS &amp; SEMI-PRECIOUS MINERALS, PROTECTED RESOURCES)'  id='choice_1_26_25'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_25' id='label_1_26_25' class='gform-field-label gform-field-label--type-inline'>SMUGGLING (DIAMONDS, GOLD, MINERALS, PRECIOUS &amp; SEMI-PRECIOUS MINERALS, PROTECTED RESOURCES)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_26'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.26' type='checkbox'  value='DRUG TRAFFICKING'  id='choice_1_26_26'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_26' id='label_1_26_26' class='gform-field-label gform-field-label--type-inline'>DRUG TRAFFICKING<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_27'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.27' type='checkbox'  value='ENVIRONMENTAL CRIME'  id='choice_1_26_27'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_27' id='label_1_26_27' class='gform-field-label gform-field-label--type-inline'>ENVIRONMENTAL CRIME<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_28'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.28' type='checkbox'  value='SMURFING'  id='choice_1_26_28'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_28' id='label_1_26_28' class='gform-field-label gform-field-label--type-inline'>SMURFING<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_29'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.29' type='checkbox'  value='EXTORTION'  id='choice_1_26_29'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_29' id='label_1_26_29' class='gform-field-label gform-field-label--type-inline'>EXTORTION<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_31'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.31' type='checkbox'  value='STOCK THEFT'  id='choice_1_26_31'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_31' id='label_1_26_31' class='gform-field-label gform-field-label--type-inline'>STOCK THEFT<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_32'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.32' type='checkbox'  value='FORGERY'  id='choice_1_26_32'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_32' id='label_1_26_32' class='gform-field-label gform-field-label--type-inline'>FORGERY<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_33'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.33' type='checkbox'  value='STRUCTURING'  id='choice_1_26_33'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_33' id='label_1_26_33' class='gform-field-label gform-field-label--type-inline'>STRUCTURING<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_34'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.34' type='checkbox'  value='FRAUD'  id='choice_1_26_34'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_34' id='label_1_26_34' class='gform-field-label gform-field-label--type-inline'>FRAUD<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_35'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.35' type='checkbox'  value='TAX EVASION'  id='choice_1_26_35'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_35' id='label_1_26_35' class='gform-field-label gform-field-label--type-inline'>TAX EVASION<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_36'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.36' type='checkbox'  value='FRAUD ATM'  id='choice_1_26_36'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_36' id='label_1_26_36' class='gform-field-label gform-field-label--type-inline'>FRAUD ATM<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_37'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.37' type='checkbox'  value='TERRORISM'  id='choice_1_26_37'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_37' id='label_1_26_37' class='gform-field-label gform-field-label--type-inline'>TERRORISM<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_38'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.38' type='checkbox'  value='HAWALA'  id='choice_1_26_38'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_38' id='label_1_26_38' class='gform-field-label gform-field-label--type-inline'>HAWALA<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_39'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.39' type='checkbox'  value='THEFT OF EXPLOSIVES'  id='choice_1_26_39'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_39' id='label_1_26_39' class='gform-field-label gform-field-label--type-inline'>THEFT OF EXPLOSIVES<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_41'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.41' type='checkbox'  value='HUMAN TRAFFICKING\/SMUGGLING OF MIGRANTS'  id='choice_1_26_41'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_41' id='label_1_26_41' class='gform-field-label gform-field-label--type-inline'>HUMAN TRAFFICKING\/SMUGGLING OF MIGRANTS<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_42'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.42' type='checkbox'  value='THEFT OF FIREARMS'  id='choice_1_26_42'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_42' id='label_1_26_42' class='gform-field-label gform-field-label--type-inline'>THEFT OF FIREARMS<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_43'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.43' type='checkbox'  value='ILLICIT ARMS TRAFFICKING'  id='choice_1_26_43'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_43' id='label_1_26_43' class='gform-field-label gform-field-label--type-inline'>ILLICIT ARMS TRAFFICKING<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_44'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.44' type='checkbox'  value='OTHER'  id='choice_1_26_44'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_44' id='label_1_26_44' class='gform-field-label gform-field-label--type-inline'>OTHER<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_93\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_93'>Report Indicators (Other)<\/label><div class='ginput_container ginput_container_text'><input name='input_93' id='input_1_93' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_28' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_1_28' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_3' class='gform_page' data-js='page-field-id-28' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_29\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">PART E1: PARTICULARS OF PERSON BEING REPORTED AS A PARTY TO ACTIVITY\/ATTEMPTED TRANSACTION<\/h3><\/div><div id=\"field_1_30\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_30'>First Name<\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_1_30' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_31\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_31'>Last Name<\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_1_31' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_32\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date of Birth<\/legend><div id='input_1_32' class='ginput_container ginput_complex gform-grid-row'>\n                                            <div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_1_32_3_container'>\n                                                <input type='number' maxlength='4' name='input_32[]' id='input_1_32_3' value=''   aria-required='false'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                                <label for='input_1_32_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                            <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_1_32_1_container'>\n                                                <input type='number' maxlength='2' name='input_32[]' id='input_1_32_1' value=''   aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                                <label for='input_1_32_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                            <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_1_32_2_container'>\n                                                <input type='number' maxlength='2' name='input_32[]' id='input_1_32_2' value=''   aria-required='false'   placeholder='DD' min='1' max='31' step='1'\/>\n                                                <label for='input_1_32_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                           <\/div>\n                                        <\/div><\/fieldset><div id=\"field_1_57\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_57'>Nationality<\/label><div class='ginput_container ginput_container_text'><input name='input_57' id='input_1_57' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_58\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_58'>Occupation<\/label><div class='ginput_container ginput_container_text'><input name='input_58' id='input_1_58' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_34\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_3col gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Identification<\/legend><div class='gfield_description' id='gfield_description_1_34'>At least one should be provided<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_34'>\n\t\t\t<div class='gchoice gchoice_1_34_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='ID Number'  id='choice_1_34_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_34\"   \/>\n\t\t\t\t\t<label for='choice_1_34_0' id='label_1_34_0' class='gform-field-label gform-field-label--type-inline'>ID Number<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_34_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Passport'  id='choice_1_34_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_34_1' id='label_1_34_1' class='gform-field-label gform-field-label--type-inline'>Passport<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_34_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Driver&#039;s License'  id='choice_1_34_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_34_2' id='label_1_34_2' class='gform-field-label gform-field-label--type-inline'>Driver's License<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_35\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_35'>ID Number<\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_1_35' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_37\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_37'>Passport Number<\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_1_37' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_36\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_36'>License Number<\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_1_36' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_59\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_59'>Identification Issue Country<\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_1_59' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_38\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">PERSON PHONE AND ADDRESS DETAILS<\/h3><\/div><div id=\"field_1_39\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_39'>Telephone Number<\/label><div class='gfield_description' id='gfield_description_1_39'>With area code<\/div><div class='ginput_container ginput_container_phone'><input name='input_39' id='input_1_39' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_1_39\"  \/><\/div><\/div><div id=\"field_1_74\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_74'>Cellphone Number<\/label><div class='gfield_description' id='gfield_description_1_74'>With area code<\/div><div class='ginput_container ginput_container_phone'><input name='input_74' id='input_1_74' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_1_74\"  \/><\/div><\/div><div id=\"field_1_41\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_41'>Postal Address<\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_1_41' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_42\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_42'>Street Address<\/label><div class='ginput_container ginput_container_text'><input name='input_42' id='input_1_42' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_43\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_43'>City\/Town<\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_1_43' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_44\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_44'>Country<\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_1_44' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_45\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">EMPLOYER INFORMATION<\/h3><\/div><div id=\"field_1_46\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_46'>Name of Employer<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_1_46' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_47' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_1_47' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_4' class='gform_page' data-js='page-field-id-47' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_48\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">PART E2: PARTICULARS OF ACCOUNTS INVOLVED IN ACTIVITY\/ATTEMPTED TRANSACTION<\/h3><\/div><div id=\"field_1_49\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_49'>Account Name\/Holder<\/label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_1_49' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_50\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_50'>Account Number<\/label><div class='gfield_description' id='gfield_description_1_50'>Where the transaction was made.<\/div><div class='ginput_container ginput_container_text'><input name='input_50' id='input_1_50' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_50\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_51\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_51'>Institution Name<\/label><div class='gfield_description' id='gfield_description_1_51'>Where account is held.<\/div><div class='ginput_container ginput_container_text'><input name='input_51' id='input_1_51' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_51\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_52\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">PART E2-1: ACCOUNT SIGNATORY INFORMATION<\/h3><\/div><div id=\"field_1_53\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_53'>First Name<\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_1_53' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_54\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_54'>Last Name<\/label><div class='ginput_container ginput_container_text'><input name='input_54' id='input_1_54' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_55\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date of Birth<\/legend><div id='input_1_55' class='ginput_container ginput_complex gform-grid-row'>\n                                            <div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_1_55_3_container'>\n                                                <input type='number' maxlength='4' name='input_55[]' id='input_1_55_3' value=''   aria-required='false'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                                <label for='input_1_55_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                            <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_1_55_1_container'>\n                                                <input type='number' maxlength='2' name='input_55[]' id='input_1_55_1' value=''   aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                                <label for='input_1_55_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                            <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_1_55_2_container'>\n                                                <input type='number' maxlength='2' name='input_55[]' id='input_1_55_2' value=''   aria-required='false'   placeholder='DD' min='1' max='31' step='1'\/>\n                                                <label for='input_1_55_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                           <\/div>\n                                        <\/div><\/fieldset><div id=\"field_1_60\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_60'>Nationality<\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_1_60' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_61\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_61'>Occupation<\/label><div class='ginput_container ginput_container_text'><input name='input_61' id='input_1_61' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_56\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_3col gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Identification<\/legend><div class='gfield_description' id='gfield_description_1_56'>If available.<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_56'>\n\t\t\t<div class='gchoice gchoice_1_56_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='ID Number'  id='choice_1_56_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_56\"   \/>\n\t\t\t\t\t<label for='choice_1_56_0' id='label_1_56_0' class='gform-field-label gform-field-label--type-inline'>ID Number<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_56_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Passport'  id='choice_1_56_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_56_1' id='label_1_56_1' class='gform-field-label gform-field-label--type-inline'>Passport<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_56_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Driver&#039;s License'  id='choice_1_56_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_56_2' id='label_1_56_2' class='gform-field-label gform-field-label--type-inline'>Driver's License<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_63\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_63'>ID Number<\/label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_1_63' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_64\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_64'>Passport Number<\/label><div class='ginput_container ginput_container_text'><input name='input_64' id='input_1_64' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_65\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_65'>License Number<\/label><div class='ginput_container ginput_container_text'><input name='input_65' id='input_1_65' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_66\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_66'>Identification Issue Country<\/label><div class='ginput_container ginput_container_text'><input name='input_66' id='input_1_66' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_67\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">PERSON PHONE AND ADDRESS DETAILS<\/h3><\/div><div id=\"field_1_68\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_68'>Telephone Number<\/label><div class='gfield_description' id='gfield_description_1_68'>With area code<\/div><div class='ginput_container ginput_container_phone'><input name='input_68' id='input_1_68' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_1_68\"  \/><\/div><\/div><div id=\"field_1_69\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_69'>Cellphone Number<\/label><div class='gfield_description' id='gfield_description_1_69'>With area code<\/div><div class='ginput_container ginput_container_phone'><input name='input_69' id='input_1_69' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_1_69\"  \/><\/div><\/div><div id=\"field_1_70\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_70'>Address<\/label><div class='ginput_container ginput_container_text'><input name='input_70' id='input_1_70' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_101\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_101'>City\/Town<\/label><div class='ginput_container ginput_container_text'><input name='input_101' id='input_1_101' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_71\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">EMPLOYER INFORMATION<\/h3><\/div><div id=\"field_1_73\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_73'>Name of Employer<\/label><div class='ginput_container ginput_container_text'><input name='input_73' id='input_1_73' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_40\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_40'>Telephone Number<\/label><div class='gfield_description' id='gfield_description_1_40'>With area code<\/div><div class='ginput_container ginput_container_phone'><input name='input_40' id='input_1_40' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_1_40\"  \/><\/div><\/div><div id=\"field_1_75\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_75'>Address<\/label><div class='gfield_description' id='gfield_description_1_75'>Postal or street address<\/div><div class='ginput_container ginput_container_phone'><input name='input_75' id='input_1_75' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_1_75\"  \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_77' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_1_77' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_5' class='gform_page' data-js='page-field-id-77' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_78\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">PART E3: PARTICULARS OF ENTITY REPORTED AS A PARTY TO ACTIVITY\/ATTEMPTED TRANSACTION<\/h3><\/div><div id=\"field_1_79\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_79'>Name of Entity<\/label><div class='ginput_container ginput_container_text'><input name='input_79' id='input_1_79' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_80\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_80'>Type of Business<\/label><div class='ginput_container ginput_container_text'><input name='input_80' id='input_1_80' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_81\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">ENTITY PHONE AND ADDRESS DETAILS<\/h3><\/div><div id=\"field_1_83\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_83'>Telephone number<\/label><div class='gfield_description' id='gfield_description_1_83'>With area code<\/div><div class='ginput_container ginput_container_phone'><input name='input_83' id='input_1_83' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_1_83\"  \/><\/div><\/div><div id=\"field_1_84\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_84'>Cellphone number<\/label><div class='gfield_description' id='gfield_description_1_84'>With area code<\/div><div class='ginput_container ginput_container_phone'><input name='input_84' id='input_1_84' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_1_84\"  \/><\/div><\/div><div id=\"field_1_85\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_85'>Postal Address<\/label><div class='ginput_container ginput_container_text'><input name='input_85' id='input_1_85' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_86\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_86'>Postal Address<\/label><div class='ginput_container ginput_container_text'><input name='input_86' id='input_1_86' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_87\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_87'>City\/Town<\/label><div class='ginput_container ginput_container_text'><input name='input_87' id='input_1_87' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_88\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_88'>Country<\/label><div class='ginput_container ginput_container_text'><input name='input_88' id='input_1_88' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_89\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">DIRECTOR INFORMATION<\/h3><\/div><div id=\"field_1_90\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_90'>First Name<\/label><div class='ginput_container ginput_container_text'><input name='input_90' id='input_1_90' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_91\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_91'>Last Name<\/label><div class='ginput_container ginput_container_text'><input name='input_91' id='input_1_91' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_92\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_5col gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Role in Organization<\/legend><div class='gfield_description' id='gfield_description_1_92'>Destination Funds Code - Disposition of Funds<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_92'><div class='gchoice gchoice_1_92_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.1' type='checkbox'  value='Accountant'  id='choice_1_92_1'   aria-describedby=\"gfield_description_1_92\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_92_1' id='label_1_92_1' class='gform-field-label gform-field-label--type-inline'>Accountant<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_92_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.2' type='checkbox'  value='Auditor'  id='choice_1_92_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_92_2' id='label_1_92_2' class='gform-field-label gform-field-label--type-inline'>Auditor<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_92_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.3' type='checkbox'  value='Beneficial Owner'  id='choice_1_92_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_92_3' id='label_1_92_3' class='gform-field-label gform-field-label--type-inline'>Beneficial Owner<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_92_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.4' type='checkbox'  value='Company Secretary'  id='choice_1_92_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_92_4' id='label_1_92_4' class='gform-field-label gform-field-label--type-inline'>Company Secretary<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_92_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.5' type='checkbox'  value='CEO'  id='choice_1_92_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_92_5' id='label_1_92_5' class='gform-field-label gform-field-label--type-inline'>CEO<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_92_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.6' type='checkbox'  value='Director'  id='choice_1_92_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_92_6' id='label_1_92_6' class='gform-field-label gform-field-label--type-inline'>Director<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_92_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.7' type='checkbox'  value='General Attendant\/Drivers'  id='choice_1_92_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_92_7' id='label_1_92_7' class='gform-field-label gform-field-label--type-inline'>General Attendant\/Drivers<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_92_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.8' type='checkbox'  value='Stakeholder'  id='choice_1_92_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_92_8' id='label_1_92_8' class='gform-field-label gform-field-label--type-inline'>Stakeholder<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_92_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.9' type='checkbox'  value='Unknown'  id='choice_1_92_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_92_9' id='label_1_92_9' class='gform-field-label gform-field-label--type-inline'>Unknown<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_92_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.11' type='checkbox'  value='Other'  id='choice_1_92_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_92_11' id='label_1_92_11' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_94\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_94'>Role in Organization (Other)<\/label><div class='ginput_container ginput_container_text'><input name='input_94' id='input_1_94' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_96' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_1_96' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_6' class='gform_page' data-js='page-field-id-96' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_97\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">PART F: GOODS\/SERVICES INVOLVED IN ACTIVITY<\/h3><\/div><fieldset id=\"field_1_98\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_5col gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Goods\/Services<\/legend><div class='gfield_description' id='gfield_description_1_98'>Destination Funds Code - Disposition of Funds<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_98'><div class='gchoice gchoice_1_98_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.1' type='checkbox'  value='Equipment'  id='choice_1_98_1'   aria-describedby=\"gfield_description_1_98\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_1' id='label_1_98_1' class='gform-field-label gform-field-label--type-inline'>Equipment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.2' type='checkbox'  value='Firearm'  id='choice_1_98_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_2' id='label_1_98_2' class='gform-field-label gform-field-label--type-inline'>Firearm<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.3' type='checkbox'  value='Furniture'  id='choice_1_98_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_3' id='label_1_98_3' class='gform-field-label gform-field-label--type-inline'>Furniture<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.4' type='checkbox'  value='Jewelry'  id='choice_1_98_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_4' id='label_1_98_4' class='gform-field-label gform-field-label--type-inline'>Jewelry<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.5' type='checkbox'  value='Land'  id='choice_1_98_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_5' id='label_1_98_5' class='gform-field-label gform-field-label--type-inline'>Land<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.6' type='checkbox'  value='Leasehold'  id='choice_1_98_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_6' id='label_1_98_6' class='gform-field-label gform-field-label--type-inline'>Leasehold<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.7' type='checkbox'  value='Property'  id='choice_1_98_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_7' id='label_1_98_7' class='gform-field-label gform-field-label--type-inline'>Property<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.8' type='checkbox'  value='Shares &amp; Interest'  id='choice_1_98_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_8' id='label_1_98_8' class='gform-field-label gform-field-label--type-inline'>Shares &amp; Interest<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.9' type='checkbox'  value='EFT'  id='choice_1_98_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_9' id='label_1_98_9' class='gform-field-label gform-field-label--type-inline'>EFT<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.11' type='checkbox'  value='Vehicle'  id='choice_1_98_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_11' id='label_1_98_11' class='gform-field-label gform-field-label--type-inline'>Vehicle<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.12' type='checkbox'  value='Other'  id='choice_1_98_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_12' id='label_1_98_12' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_99\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_99'>Goods\/Services (Other)<\/label><div class='ginput_container ginput_container_text'><input name='input_99' id='input_1_99' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_100\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_100'>Item Description<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_100' id='input_1_100' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='submit' id='gform_submit_button_1' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_1' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_1' id='gform_theme_1' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_1' id='gform_style_settings_1' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='hQvvYi3gLAv5c34Gir2WmxThPLOjFAemlw9WDsuAHxKVlOK4wlFnhFBbhJorFH2tcgbqO5C\/9QpaXKQtEHvxjul34WEKi68\/oS5a39VIEUD2tkA=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_1' 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